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Clozapine Withdrawal Related Mania in an Adolescent: Case Report

Year: 2025

Type: article

Abstract: Clozapine discontinuation is known to trigger withdrawal-associated psychosis, but non-psychotic withdrawal symptoms, though clinically significant, are less frequently discussed. Proposed mechanisms include dopaminergic receptor upregulation, cholinergic rebound, and serotonergic dysregulation. No previous reports describe clozapine withdrawal-associated mania in pediatric patients, and only three cases of withdrawal-related mania have been described in adults. We describe a 16-year-old female with schizophrenia who had previously shown limited response and poor tolerability to multiple antipsychotics. Since clozapine is known to be effective in psychotic symptoms nonresponsive to other antipsychotics, it was initiated during hospitalization and titrated to 250 mg/day. It was stopped after 7 days at the target dose due to suspected myocarditis. After 4 days, the patient presented with elated mood, tachypsychia, hypersexuality, and decreased need for sleep, without psychotic symptoms. Symptoms resolved over 10 days with olanzapine. Psychotic symptoms re-emerged post-discharge, in the absence of mood features. This appears to be the first report of clozapine withdrawal-associated mania in an adolescent without a previous mood disorder. Earlier cases have only involved adults with schizoaffective disorder and long-term treatment. While schizoaffective disorder was considered in this case, the brief duration of symptoms, full remission with antipsychotic monotherapy, and close temporal link to clozapine cessation favor a withdrawal-related phenomenon. This case exposes for the first time in the literature the onset of manic symptoms following clozapine withdrawal in an adolescent with only psychotic symptoms before this trial. This report raises awareness for the importance of monitoring different effects during and after psychopharmacologic treatment, other than the reappearance of psychotic symptomatology. It also raises questions about diagnostic evolution in early-onset psychosis.

Source: Journal of Indian Association for Child and Adolescent Mental Health

DOI: 10.1177/09731342251407477

Authors: Joana Coelho Santos, Marta Abrantes, Luísa Queiroga

Institution: Unidade Local de Saúde de São José

Language: English

Topic: Schizophrenia research and treatment

Subfield: Psychiatry and Mental health

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

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