Abstract

an AntimanicEffect?SIR: In “Antimanic Effects ofVerapamil” issue), A. James Giannini, M.D., and(December1984 those ofantidepressant same patient case. Ms.medication over time,can change at the same dose in the as demonstrated by the followingA, a 59-year-olddepression overwoman,a period ofhad beenlithium, an agent that possibly has opiatergic activity Giannini and associates suggested that one possible nism of action of verapamil is through cellular calcium(1). Dr. mechainflux12 yearsblockade. Recently, however, verapamil has been shown to block central serotonin (S-HT) receptors (2). Moreover, blockade of S-HT receptors has been shown to block the antinociceptive effects of morphine (3). Furthermore, it recently has been shown that the acute effects of opiate administration are mediated through a direct effect of voltage-sensitive calcium channels (4). Endorphin excess has been suggested to underlie euphoria and mania (5). An antimanic effect of verapamil could thus be produced by blockade of endorphinergic activity, secondary to either blockade of serotonin with the activity of opiates through metabolism. activity or their effect interference on calciumtreated over a period of several years by three different nonmedical therapists, two of whom had actively advised the patient not to seek medical treatment for her disorder. Because of her resultant apprehension, she was begun on