UC San Diego

Mania is a defining feature of bipolar disorder, although its pathophysiology remains incompletely understood. Multiple substances are known to precipitate mania in susceptible individuals. Here we describe the case of a 22-year-old male with no prior psychiatric history, who was hospitalized due to mania three times within four months. Each relapse corresponded to either increasing or restarting creatine supplementation. The patient met DSM-5-TR criteria for bipolar I disorder. However, the full and rapid recovery with each episode, similar symptoms in a first-degree relative that resolved on cessation, and the consistent temporal relationship with creatine supplementation raise the possibility that creatine contributed to precipitating these symptoms. Causality was rated as probable on the Naranjo Adverse Drug Reaction Probability Scale. This case suggests a possible link between creatine supplementation and mania. It also highlights the importance of screening for supplement use in patients presenting new-onset mood symptoms and offers ideas for further research.