TO THE EDITOR: Levetiracetam is a novel antiepileptic drug with antikindling properties but no known mechanism that directly affects inhibitory neurotransmitters or excitatory amino acids. Although a number of newer anticonvulsants have begun to receive attention for their possible antimanic and/or antidepressant efficacy, we know of no published reports regarding these potential properties of levetiracetam. We report a patient with acute mania that stabilized with open-label levetiracetam monotherapy, recurred after drug cessation, and restabilized after drug reintroduction.

Mr. A was a 42-year-old divorced white man with a 27-year history of nonrapid-cycling bipolar I disorder. He had no psychiatric comorbidities according to the Structured Clinical Interview for DSM-IV (1) a 2–3 month history of elevated mood, pressured speech, sleeplessness, and related symptoms, and subthreshold depression (a baseline score of 25 on the Young Mania Rating Scale [2] and a score of 16 on the 31-item Hamilton Depression Rating Scale). Mr. A had experienced his first manic episode at age 15 and his first depressive episode at age 35. He had four lifetime psychiatric hospitalizations and had attempted suicide at age 39. Previous episodes had been modestly responsive to adequate trials of lithium, divalproex, carbamazepine, conventional neuroleptics, selective serotonin reuptake inhibitors, and/or psychostimulants. A 6-week trial of 1000 mg/day of divalproex and 15 mg/day of olanzapine was discontinued because of sedation and nausea, after only partial improvement of his current mania.