Interactions between Lithium and Tetracycline?
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Q:  Interactions between Lithium and Tetracycline?

My husband recently had a tetracycline antibiotic injected into his gums during a dental procedure at 10:00 am.  Within  9 hours I observed a "slight" shift in him toward agitation and mild hypomania; by the next morning (21 hours later) I observed a significant worsening of his existing depression; by that evening extreme agitation and irrational, reactive and almost paranoid thinking toward me. 

He is taking only 600 mg lithium per day, usually at night.  On this particular instance, he had forgotten to take it the night before the dental procedure, and took the dosage in the morning, approx. 2-3 hours before the gum injection.

I've researched all I can find and although I find that tetracycline can elevate lithium serum levels, possibly resulting in lithium toxicity, I see nothing that would indicate this rapid and severe mood shift after tetracycline is introduced.

I've spoke to our psychiatrist and her view is that the elevated lithium level would not have triggered this mood shift.  She doesn't seem to believe me, although she does want him to increase his lithiumm to 900.

What is your opinion on this? Are you aware of any cases like this?  I should add that my husband's chemistry is very sensitive to medications: a small amount of anything impacts him strongly.  I was there and I saw this significant mood shift, which, after 2 days came back to where it was the 3 days before the dental injection.

Background: Diagnosed 2.5 years ago w/Cyclothymia at age 47. Family history: sibling BPI; first cousin BPII; father.  First psychiatrist inappropriately put him on Lexapro, which indused hypomania and mania and HUGE UPEHAVAL IN OUR LIVES.  Then we found new doctor who prescribed Lithium.  Husband stabilized on 450 mg, for almost 2 years, for the most part.  Seven months ago due to high stress, had a hypomanic episode which was also missed by psychotherapist resulting in worsening conditions and continued destabilization for several months.  So, I'm aware that when the dental injection was given my husband was already in a "vulnerable" place, however, there absolutely was a HUGE mood swing, very rapid.
Thank you

Dear April --

As you probably did, I did literature search for tetracycline mania (Google and Pub Med). Did not find anything there. However, by your account one would have to strongly suspect that the antibiotic did indeed precipitate a mood swing. As one of my primary care doctor friends says, "medications are guilty until proven innocent" . I am certainly going to file it in my head that way, but no, I have never seen another case like this.

Dr. Phelps

Published October, 2007

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