Case report, case study

https://doi.org/10.24869/psyd.2026.80

Psychotic mania induced by metronidazole: A rare case of antibiomania

Bilge Targıtay Öztürk orcid.org/0000-0002-8524-5204 ; Department of Psychiatry, Dokuz Eylul University Medical School, Izmir, Turkey *
Yusuf Tinga ; Department of Psychiatry, Dokuz Eylul University Medical School, Izmir, Turkey
Zeynep Gül Dağlar orcid.org/0009-0008-2140-1010 ; Department of Psychiatry, Dokuz Eylul University Medical School, Izmir, Turkey
Berna Binnur Akdede orcid.org/0000-0002-2166-0732 ; Department of Psychiatry, Dokuz Eylul University Medical School, Izmir, Turkey

* Corresponding author.

Abstract

Metronidazole, a widely used antimicrobial agent, has been associated with rare neuropsychiatric adverse effects, including antibiotic-induced mania (antibiomania). We report the case of a 46-year-old woman with a history of bipolar disorder type I, previously triggered by antidepressant treatment, who presented with an acute onset of a manic episode with psychotic features following prolonged metronidazole treatment. The patient had remained euthymic and medication-free for approximately nine years prior to this episode.

Metronidazole was discontinued upon admission, and appropriate psychiatric treatment was initiated. Manic and psychotic symptoms resolved completely within three days, supporting a probable causal association. This case highlights the potential of metronidazole to induce manic episodes, particularly in individuals with a predisposition to mood disorders, and aims to discuss the possible underlying mechanisms through which metronidazole may contribute to the development of mania.

Keywords

Hrčak ID:

347062

URI

https://hrcak.srce.hr/347062

Publication date:

30.4.2026.

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