Duloxetine-Induced Manic Switch in a Patient with Bodily Distress Disorder: A Case Report and Brief Literature Review

Duloxetine, a dual-action antidepressant, is widely used to treat depression, anxiety, and chronic pain. While it is generally considered safe, rare cases of Duloxetine-induced manic switches have been reported. We present a unique case of a woman with Bodily Distress Disorder who developed manic symptoms following Duloxetine therapy. Despite a complex medical history and extensive evaluations, no prior mood disorders were diagnosed. A family history of severe mental illness was the sole predictor of bipolarity. The manic switch occurred after the discontinuation of Quetiapine, suggesting its protective role during initial therapy with Duloxetine. Manic switch is an infrequent adverse effect of Duloxetine, with only isolated reports in the literature, primarily at doses between 40–120 mg/day. A review of the existing literature underscores the rarity of Duloxetine-induced manic switches, with no new reports in the last 15 years, highlighting the need for vigilance in monitoring mood changes during Duloxetine treatment, particularly in patients with potential bipolar predictors. This case emphasizes the importance of comprehensive psychiatric assessment and careful medication monitoring to optimize treatment outcomes and minimize risks.