Etanercept, anticytokines and mania.

Cytokines influence multiple psychiatric and medical conditions. Proinflammatory cytokines are associated with depression. The novel treatment of autoimmune diseases with anticytokines presents a unique strategy to understand the role of cytokines in affective disorders. Specifically, because antidepressants can be associated with cycling into manic states, and antidepressants can be associated with resolution of cytokine-induced depression, then, hypothetically, the treatment of a vulnerable patient who has an affective disorder with an anticytokine could also result in cycling. The development of a manic episode is described in a patient with psoriatic arthritis who was treated with etanercept, a tumour necrosis factor-alpha antagonist.