Contribution of methotrexate in precipitation of manic episode in bipolar affective disorder explored: a case report

Abstract

Bipolar affective disorder is characterized by recurring episodes of mania with or without, but commonly with, episodes of depression. It usually begins in adolescence and can cause enduring and substantial impairment if left untreated. It needs a long-term treatment with mood stabilizers to prevent relapses. Elevated or depressed mood relapses can be either primary or secondary. However, primary mood relapses can occur without a significant precipitating factor, more often tending to occur following stressful life events or discontinuation of mood stabilizer medications. Secondary mood relapses can be caused by many conditions, such as physical illnesses, substance misuse and medications. When a mental illness coexists with another physical illness and the treatment of one complicates the other, it adds complexity to the selection of appropriate pharmacological regime for either condition. In this paper, the authors present a case of bipolar affective disorder who had two episodes of mania likely precipitated by methotrexate, which were reversed by the withdrawal of the offending drug (methotrexate). To the best of the authors’ knowledge, to date there have been no published reports in the literature in which methotrexate, an immunosuppressive and a cytotoxic drug, precipitated a manic episode in a patient with bipolar affective disorder.

The Relationship Between Mental Health and Drugs used in Dermatology

“…In the treatment of psoriasis, this described mechanism translates into the apoptosis of activated T cells, thereby restricting epithelial hyperplasia, a characteristic feature of the disease. [44] [45] The psychiatric side effects of methotrexate treatment are rare. In the literature, cases of psychosis and exacerbations of bipolar disorder have been described.…”

“…The authors of the case report identified the use of methotrexate as the most likely cause of the exacerbation of bipolar disorder. [45] Psoriasis is a condition that can significantly impair the quality of life, leading to anxiety, depression and lower self-esteem. A study involving 60 patients with psoriasis, treated either with methotrexate or biologic therapy, utilized the Beck Anxiety Inventory, Beck Depression Inventory and Dermatology Life Quality Index to assess their psychological well-being.…”

Challenges in Treating Cancer Patients With Unstable Psychiatric Disorder

“…After readjustment of antipsychotic therapy, symptoms subsided within 15 days. Table 2 [17,[81][82][83][84][85][86][87][88][89] summarizes chemotherapeutic agents associated with similar presentations.…”

Аффективные И Тревожные Нарушения В Колопроктологической Практике (Научный Обзор)

“…Показано, что все эти препараты могут давать нейропсихиатрические ПЭ, в частности, депрессивные и тревожные состояния [de Oliveira Ribeiro NP et al, 2013]. Описан случай провокации маниакального состояния метотрексатом [Hariram J, Jegan Y, 2013].…”

“…Патофизиологические механизмы депрессогенного влияния иммуносупрессоров цитостатического ряда могут включать в себя прямое нейротоксическое действие (угнетение нейрогенеза и способствование апоптозу нервных клеток), и, в случае метотрексата, также угнетающее влияние на активность ферментов фолатного цикла, что приводит к повышению уровня гомоцистеина, нарушению синтеза тетрагидробиоптерина (BH4) и, как следствие, нарушениям в биосинтезе моноаминов, кофактором для некоторых стадий которого BH4 является [Hariram J, Jegan Y, 2013].…”