{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T06:17:55Z","timestamp":1788675475928,"version":"build-2803163510"},"reference-count":10,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:p>Lurasidone is a second-generation antipsychotic approved for the treatment of bipolar depression. Although effective, antipsychotics may precipitate manic episodes in susceptible individuals. This report aims to describe a unique case of a patient with bipolar I disorder who developed acute mania following lurasidone titration, highlighting the need for vigilance during treatment initiation. We present the case of a 43-year-old man with a history of bipolar I disorder who presented with a severe depressive episode, characterized by depressed mood, insomnia, anhedonia, and suicidal ideation. Laboratory investigations revealed a subtherapeutic serum valproate level of less than 13 \u00b5g\/mL (reference range: 50\u2013100 \u00b5g\/mL). Lurasidone therapy was initiated and gradually titrated to 120 mg daily. After 1 week, the patient exhibited increased energy and decreased sleep needs. By the second week, he developed a full manic episode, presenting an elevated mood, irritability, intrusive behavior, and sleeping only one to two hours per night. Following the immediate discontinuation of Lurasidone, alongside the optimization of his sodium valproate dosage and the reinitiation of paliperidone, the patient experienced a dramatic reduction in his manic symptoms. His clinical condition stabilized, and he was subsequently discharged. This case emphasizes the critical importance of close monitoring for manic symptoms following lurasidone initiation in patients with bipolar I disorder and inadequate mood stabilization.<\/jats:p>","DOI":"10.3389\/fpsyt.2026.1853542","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T05:41:50Z","timestamp":1780983710000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Manic episode following lurasidone initiation in bipolar I disorder: a case report"],"prefix":"10.3389","volume":"17","author":[{"given":"Nasser M.","family":"Alzain","sequence":"first","affiliation":[{"name":"Department of Psychiatry, College of Medicine, Imam Abdulrahman Bin Faisal University","place":["Dammam, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feras A.","family":"Al-Awad","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, College of Medicine, Imam Abdulrahman Bin Faisal University","place":["Dammam, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saleh A.","family":"Alzahrani","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, College of Medicine, Imam Abdulrahman Bin Faisal University","place":["Dammam, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fahad M.","family":"Almsned","sequence":"additional","affiliation":[{"name":"Research Center, King Fahad Specialist Hospital in Dammam (KFSH-D)","place":["Dammam, Saudi Arabia"]},{"name":"Research Program, Academic, Training, and Research Administration, Eastern Health Cluster","place":["Dammam, Saudi Arabia"]},{"name":"School of Systems Biology, George Mason University","place":["Fairfax, VA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"key":"B1","unstructured":"Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology\n          \n          \n            \n              Goodwin\n              GM\n            \n            \n              Haddad\n              PM\n            \n            \n              Ferrier\n              IN\n            \n            \n              Aronson\n              JK\n            \n            \n              Barnes\n              TRH\n            \n            \n              Cipriani\n              A\n            \n          \n          \n          2016"},{"key":"B2","article-title":"Lurasidone monotherapy in the treatment of bipolar I depression: A randomized, double-blind, placebo-controlled study","volume-title":"American journal of psychiatry","year":""},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.pnpbp.2005.11.026","article-title":"Manic\/hypomanic symptoms induced by atypical antipsychotics: A review of the reported cases","volume":"30","author":"Michalopoulou","year":"2006","journal-title":"Prog Neuro-Psychopharmacol Biol Psychiatry"},{"key":"B4","article-title":"Atypical antipsychotic-induced mania\/hypomania: a review of recent case reports and clinical studies","volume-title":"International journal of psychiatry in clinical practice","year":""},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1177\/2045125316677954","article-title":"Case report of a switch to mania induced by Lurasidone","volume":"7","author":"Kanzawa","year":"2017","journal-title":"Ther Adv Psychopharmacol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.euroneuro.2014.11.010","article-title":"The pharmacodynamic properties of Lurasidone and their role in its antidepressant efficacy in bipolar disorder","volume":"25","author":"Fountoulakis","year":"2015","journal-title":"Eur Neuropsychopharmacol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1124\/jpet.110.167346","article-title":"Pharmacological profile of Lurasidone, a novel antipsychotic agent with potent 5-Hydroxytryptamine 7 (5-HT7) and 5-HT1A receptor activity","volume":"334","author":"Ishibashi","year":"2010","journal-title":"J Pharmacol Exp Ther"},{"key":"B8","first-page":"xv","volume-title":"Stahl\u2019s essential psychopharmacology: Neuroscientific basis and practical applications, 4th ed","author":"Stahl","year":"2013"},{"key":"B9","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1111\/j.1742-1241.2010.02587.x","article-title":"Lurasidone for schizophrenia: a review of the efficacy and safety profile for this newly approved second-generation antipsychotic","volume":"65","author":"Citrome","year":"2011","journal-title":"Int J Clin Pract"},{"key":"B10","article-title":"A network meta-analysis on comparative efficacy and all-cause discontinuation of antimanic treatments in acute bipolar mania","volume-title":"Psychological medicine | Cambridge core","year":""}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1853542\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T05:41:56Z","timestamp":1780983716000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1853542\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,9]]},"references-count":10,"alternative-id":["10.3389\/fpsyt.2026.1853542"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2026.1853542","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,9]]},"article-number":"1853542"}}