Antibiomania

Antibiomania, also known as antibiotic-induced mania or antimicrobial-induced mania, is a rare but serious idiosyncratic adverse reaction in which antibiotic therapy induces mania or hypomania.^[1][2] It has been documented most commonly with clarithromycin, followed by other antibiotics including fluoroquinolones and isoniazid, among others.^[1][3] Psychosis and other symptoms may occur in addition to or instead of mania.^[1][4] Antibiomania is treated by discontinuation of the causative antibiotic, usually resulting in rapid and dramatic improvement, and/or with psychiatric drugs like mood stabilizers, antipsychotics, and benzodiazepines.^[1][2] The mechanisms responsible for antibiomania are unknown, but may be due to off-target central nervous system activities of certain antibiotics or due to disruption of the gut microbiome and gut–brain axis.^[1][2][5] Elevated cortisol levels have also been observed in antibiomania.^[2][1] More than 100 cases of antibiomania were identified in a major 2002 literature review.^[2][5][1] The term antibiomania was introduced in this same 2002 review.^[2][1] Psychiatric adverse effects were first associated with antibiotics like penicillin as early as 1948.^[5][6]