Response to Anandarajan et al.: Manic exacerbation induced by nicotine patch

In their letter to you, Anandarajan et al. (2012) purport that the daily use of a single 21 mg 24-hour nicotine patch for a 3-week period induced a manic episode in a 35-year-old man with a past history of bipolar disorder (BPAD). Anandarajan et al. (2012) suggest two possible explanations to account for their observation. The first relates to a disruption of the sleep/wake cycle induced by nicotine patches acting as a stimulant. The second proposed mechanism suggests that the patches stimulated nicotinic cholinergic receptors on mesolimbic dopaminergic neurons resulting in increased dopaminergic activity, and that this patient was particularly susceptible to this hyperdopaminergic activity due to ?a vulnerable brain? and not being on maintenance mood stabiliser treatment. We believe that this association between the use of nicotine patches and manic relapse is largely unfounded, and is in fact a dangerous claim to make.