Abuse of dosulepin to induce mania.

Tricyclic antidepressants sometimes trigger mania in bipolar patients, but little is known about their potential for abuse in this regard. We describe a man with bipolar disorder and alcohol dependency who abused dosulepin repeatedly in order to induce manic episodes. This caused serious problems for treatment and long-term outcome. We mention two further cases in which dosulepin or clomipramine was used deliberately to induce bipolar mania. Tricyclic antidepressants can be abused to induce mood elevation in bipolar patients. This should be considered in cases of treatment-resistant mania.