Treatment emergent mania responding to valproate in a Chinese female adolescent population with eating disorders: a case series.
Eating disorders are commonly associated with depressive symptoms. In an adolescent and binge eating population fluoxetine is commonly used to treat co-morbid depression associated with eating disorders. In some patients this may precipitate treatment emergent mania (TEM). Risk factors in the adolescent population include being older, female, having a longer duration of illness, more previous mood episodes, a higher prevalence of subclinical hypothyroidism, early-onset anxiety and recent exposure to a mood-elevating agent. Diagnosis and management of these co-morbid conditions is challenging due to the overlapping symptomatology and the adverse effects of both conditions complicating pharmacological management. This is illustrated with three cases in a Chinese female adolescent population that experienced TEM while on fluoxetine and responded to valproate.
Tor
Phern Chern
PC
Department of Psychiatry, Singapore General Hospital, Singapore. torphernchern@gmail.com
Lee
Ee Lian
EL
D000293:Adolescent; D000856:Anorexia Nervosa / Q000150:complications / Q000188:drug therapy*; D000927:Anticonvulsants / Q000627:therapeutic use; D018692:Antimanic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000209:etiology* / Q000628:therapy*; D052018:Bulimia Nervosa / Q000150:complications / Q000188:drug therapy*; D001068:Feeding and Eating Disorders / Q000150:complications* / Q000523:psychology*; D005260:Female; D006801:Humans; D007555:Isoxazoles / Q000627:therapeutic use; D008297:Male; D010672:Phenytoin / Q000627:therapeutic use; D012307:Risk Factors; D012727:Sex Characteristics; D012846:Singapore; D014635:Valproic Acid / Q000627:therapeutic use*; D055815:Young Adult; D000078305:Zonisamide
D000927:Anticonvulsants; D018692:Antimanic Agents; D007555:Isoxazoles; D000078305:Zonisamide; D014635:Valproic Acid; D010672:Phenytoin