A PubMed search revealed 14 cases of ziprasidone associated mania, which carried primary diagnoses of mood disorders, generalized anxiety disorders (GAD), panic disorder, and psychotic disorders. To our knowledge, we report the first case of mania associated with ziprasidone augmentation of a selective serotonin reuptake inhibitor in a 60-year-old man (at time of ziprasidone-induced mania) with obssessive-compulsive disorder (OCD).
In May 2002, after partial response to citalopram 80 mg and low-dose clonazepam 1.5 mg/day in three divided doses, ziprasidone was initiated as an augmenting agent at a dose of 20 mg/day and increased to 20 mg BID. Within 7 days of starting ziprasidone family members noted a decreased need for sleep, impulsivity, grandiosity, and increased energy. He was brought to the emergency room after 17 days with florid manic symptoms. Physical and neurological exams were unremarkable. Routine laboratory work, including a drug screen, was non-contributory. His non-psychiatric medications included fexofenadine, hydroxyzine, and sodium nitroprusside. He was hospitalized and ziprasidone was stopped with reduction in the dose of citalopram to 20 mg. Manic symptoms promptly resolved within 3 days.