Tramadol-associated mania: A case report.

A variety of medications, most notably tricyclic antidepressants, and other antidepressants including venlafaxine have been reported to have triggered manic episodes in patients with bipolar disorder. The synthetic opioid tramadol has also been associated with mania activation. This report describes an unusual case of tramadol-associated mania in a patient without a charted diagnosis of bipolar disorder. However, she had a history of two prior episodes of mania following administration of tramadol that were also believed to be related to medication-induced mood disorder rather than underlying bipolar disorder. We hypothesize that tramadol-associated mania may have an underlying mechanism involving monoamine neurotransmission and increased oxidative stress.