Are Hypomanic/Manic Episodes “Induced by” or “Associated with” Quetiapine Initiation?

An increasing number of case reports are concerned with hypomanic/manic symptoms induced by some atypical antipsychotic drugs, especially quetiapine [1]. In the current volume of Drug Safety—Case Reports, the case series published by Rovera et al. [2] demonstrates that quetiapinerelated hypomania is an interesting event that is worth being appropriately diagnosed and managed in patients with bipolar disorder. Quetiapine is a second-generation dibenzothiazepine antipsychotic drug approved for the treatment of schizophrenia, major depression, bipolar disorder, bipolar depression, and mania. Several randomized, double-blind, placebo-controlled studies with quetiapine in bipolar depression included treatment-induced hypomania/mania as a secondary outcome, although the incidence of treatment-induced hypomania/mania with quetiapine at a dose of 300 or 600 mg/day seems no higher than that with placebo [3–5]. Possible Pharmacologic Reasons Behind Quetiapine-Related Hypomania/Mania