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Pharmacopsychiatry 2002; 35(5): 197-199
DOI: 10.1055/s-2002-34121
Case Report
© Georg Thieme Verlag Stuttgart · New York

Charcoal Enhancement of Treatment for Tricyclic-Induced Mania

V. Jain1 , C. M. Swartz1
  • 1Department of Psychiatry, Southern Illinois University School of Medicine, Springfield, Illinois, USA
This paper was presented in part at the Annual Meeting of the American Academy of Clinical Psychiatrists, St. Louis, Missouri, October 13, 2000.
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Publication History

Received: 4. 9. 2001 Revised: 15. 2. 2002

Accepted: 7. 3. 2002

Publication Date:
18 September 2002 (online)

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Induction of mania by tricyclic antidepressants (TCAs) is controversial, with indirect evidence for and against it. Unusual direct evidence of it was observed in a 77-year-old female patient having ingested an amitriptyline overdose. Mania developed while the TCA blood levels were high, and responded to a combination of charcoal and valproate. However, mania reappeared when charcoal was discontinued, and disappeared again when it was restarted. This time course suggests a therapeutic advantage for adding charcoal to valproate in treating tricyclic-induced mania. Presumably, charcoal might have removed a mania-inducing metabolite of amitriptyline. Moreover, repeated doses of oral activated charcoal accelerated the elimination of TCA from the blood stream to several times its original rate, which is consistent with interruption of the enterohepatic circulation. This enhanced elimination and improved outcome illustrate the value of repeated charcoal doses after TCA overdose, and suggest its use when mania develops in a patient who takes an antidepressant, at least amitriptyline or nortriptyline.

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Conrad Swartz, Ph.D., M.D.

Department of Psychiatry

Southern Illinois University School of Medicine


PO Box 19642, Springfield, IL 62794-9642

USA

Phone: +1 (217) 545-3935 x 44468

Fax: +1 (217) 545-2275

Email: cswartz@siumed.edu

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