Publication:

From depression to hypomania: antidepressant-triggered switching in a bipolar patient with phenotypic mitochondrial features

Antidepressant-induced mania (AIM) is a recognized complication in bipolar disorder, particularly in patients with neurobiological vulnerabilities. Mitochondrial dysfunction, which impairs neuronal energy metabolism, has been implicated in both bipolar pathophysiology and antidepressant sensitivity. We report the case of a 25-year-old woman with bipolar disorder who presented with a two-month history of worsening depressive symptoms. Her medical history included exercise intolerance since adolescence, recurrent migraine headaches. Given her persistent low mood, sertraline was initiated. Within 10 days, she developed pressured speech, decreased need for sleep, and increased goal-directed activity, consistent with hypomania. The antidepressant was discontinued. She remains stable on lurasidone with maintenance ketamine infusions every 7 weeks. This case illustrates the potential role of mitochondrial dysfunction as a biological amplifier for polarity switching in bipolar disorder. Systemic features of mitochondrial impairment may warrant greater caution with antidepressant use, with emphasis on mood stabilizer-centered regimens and close monitoring for early signs of mood elevation.