Mannitol-Induced Acute Manic State

Letter to the Editor

Sir: We present an interesting case of possible mannitolinduced manic state in a depressed elderly woman.

Case report. Ms. A, a previously well-adapted 75-yearold woman without personal or family history of mental disorders, presented with a first episode of severe major depression (DSM-IV criteria). On the 10th day of antidepressant treatment with nortriptyline, 50 mg/day, a diagnosis of bilateral acute angle closure glaucoma was made. Continuous intravenous infusion of mannitol 20% (500 cm3 in 1 hour), oral acetazolamide (500 mg), and topical treatment with pilocarpine 2% (1 drop/15min), timolol 0.50% (1 drop/15 min), and dexamethasone 0.1% (1 drop/15 min) were prescribed simultaneously. Thirty minutes later, when her pain had diminished, Ms. A became euphoric, and she remained overactive, overly affectionate, and talkative, showing pressured speech and flight of ideas and telling jokes. Her manic state remitted in 1 hour after cessation of mannitol infusion, and her severe depression came back dramatically.