Q:  Can Imitrex Esculate a Manic Episode?

I am currently cycling.  I am experiencing a mixed episode.  I am also having migraines.  The general practitioner prescribed Imitrex 25mg.  Can the ingredients in Imitrex esculate a manic episode?
 

Dear Ms. M. -- 

That's a good question.  You're probably referring to the known effects of Imitrex on serotonin.  Since other medications which affects serotonin, namely antidepressants, can increase manic symptoms, we should ask whether Imitrex (sumatriptan) can do so. 

Surprisingly, entering sumatriptan mania in PUB MED (a search engine for the national Library of medicine; you can read about how to use this engine yourself) yields only seven articles.  Usually searches of this database yield many more studies.  So this is an indication that if there is a connection, it is not widely recognized.  None of the seven articles describe a worsening of mania. 

However, there is a case report of the induction of hypomania with another anti-migraine medication similar to sumatriptan: frovatriptan.  That report was published in 2005. I did not find that until I used good old Google. 

Overall, I would say that the difficulty in finding articles describing a problem with the “triptan” class of anti-migraine medications suggests that if there is a risk of inducing manic symptoms with these medications, it is very small.  So far, one does not see recommendations for avoiding these medications in patients with bipolar disorder, in our psychiatric literature. Just to make sure, I did one more search using Google, entering triptan bipolar.  The first link comes back to another letter here at BipolarWorld that I wrote addressing the same question in 2004 (that's a long time ago.  I had forgotten.) I gave the same answer then.   

So, within the limitations of our knowledge base, it looks like the use of triptan anti-migraines in people with bipolar disorder is it okay. 

Dr. Phelps




Published July, 2008