Caution should be exercised when prescribing nicotine replacement therapies for patients with mental illness, psychiatrists warn, after a patch appeared to trigger a manic episode in a man with bipolar disorder.
Their case report documents the mental deterioration of a 35-year-old man who had a history of bipolar disorder but no “unremarkable” lifestyle changes, except for recently quitting smoking and commencing maximum (21 mg) strength nicotine patches.
After starting the patches, the patient was unable to sleep, became irritable and showed uncontrollable anger and physically aggression, the authors write in the Australia and NZ Journal of Psychiatry.
“The quick resolution of his manic symptoms on a relatively low dose of quetiapine and with the cessation of nicotine patches... suggested a possible correlation between excessive nicotine levels and the precipitation of a manic episode,” they say.
Nicotine may have triggered mania by disrupting the patient’s sleep/wake cycle, or possibly through the stimulation of his dopaminergic system, the psychiatrists suggest.
“The understanding of this potential risk is of clinical relevance given increased use of nicotine patches after the implementation of the non-smoking policy within health settings,” they say.
They add it also highlights the importance of educating patients about potential stimulant and/or overdose effects of nicotine patches.
