Manic episodes linked to infection and antibiotics

A new study from John Hopkins Medicine found a link between manic episodes in people with serious mental disorders, and infection and antibiotic use. In a previous study, the researchers discovered that people who had been hospitalized for mania “had markers suggesting that their immune system was turned on. But we didn’t actually know the cause of this,” says Robert Yolken, M.D., the Theodore and Vada Stanley Distinguished Professor of Neurovirology in Pediatrics at the Johns Hopkins University School of Medicine.

In their recent research, Yolken and his team wanted to understand the cause of immune system activation in people diagnosed with mania. “[We] simply asked the people and checked their records about whether they had had exposure to antibiotics-that’s the way we define infections,” says Yolken. Many women were being treated for urinary tract infections and men were being treated for a range of different kinds of infections.

The John Hopkins researchers measured manic episodes based on the DSM criteria, which is defined by the Centre for Addiction and Mental Health (CAMH) as “abnormally and continuously high, happy, expansive and euphoric, or irritable, angry, disruptive and aggressive” behaviour that lasts more than one week or is severe enough for hospitalization. This change in behaviour has to be accompanied by at least three of seven other symptoms, such as decreased need for sleep, poor judgement and increased talking.

“We found that people who had these manic episodes […] were much more likely to have been exposed to an antibiotic than people who were either of the controls-that is people who were healthy or people who were admitted to the hospital, say, for episodes for other psychiatric disorders like schizophrenia or depression,” Yolken says. “We were pretty surprised to find that it was so common in this mania population.”

It is still unclear whether it is the infection, the treatment or some combination of the two linked to an increased incidence of manic episodes. However, the research done by Yolken and the John Hopkins researchers can be used as a foundation for future studies that look at infection and antibiotics separately in people diagnosed with mania. And, in the meantime, knowledge of a relationship between mania and infections and antibiotics can help to inform clinicians and patients about preventing manic episodes.

“We certainly think that people who have a history of manic episodes or may have some other reason for having higher risk, perhaps a family history, certainly should do what they can to prevent infections.” says Yolken. “Any infection they have should be treated early and with a minimal amount of antibiotics and the most specific antibiotic that can be used. And that’s probably a good practice for everybody for a variety of reasons, but that would be particularly true in this population.”