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Phenylephrine, pseudoephedrine and ephedrine are the sympathomimetic drugs that have been used most commonly in the oral preparation medication for the relief of nasal congestion. The psychiatric cases have been reported to be triggered by CNS stimulant drugs which have been used as the nasal decongestants. In this article, we would like to present a male patient with bipolar disorder with two manic episodes and both of them triggered by anti-flu drugs. 25 year old male patient was admitted to psychiatric outpatient clinic with increasing complaints such as increasing energy, talkativeness, decreasing sleep, increasing in libido and visual and auditory hallucinations after using the anti-flu drug containing phenylephrine. Also, 2 years ago, he has had a manic attack triggered after the use of anti-flu drug. The patient’s manic symptoms were stabilized with lithium 900 mg / day and olanzapine 15 mg / day and his functionality was improved. According to the history, the psychometric tests, the psychiatric evaluation, and the 6 months follow-up, he was diagnosed with "substance/medication induced bipolar and related disorder" according to DSM 5 diagnostic criteria. In our case; no mood or psychosis episode before the use of nasal decongestants, no family history of bipolar disorder, 16 months of well being without using a mood stabilizer between 2 episodes, remission in 1 month antimanic treatment after the cessation of anti-flu drug strengthens the view that the adrenergic drugs with a central stimulant effect may trigger the manic episodes.

Can nasal decongestants trigger a manic episode?