Selegiline and Manic Behavior in Parkinson's Disease

To the Editor. —Selegiline is known to produce a variety of behavioral side effects, including hallucinations, nightmares, and sleep disturbance. A sensation of increased energy may occur at doses greater than 10 mg/d. 1 Hypomania has been reported in a patient who received selegiline 5 mg twice daily immediately following adrenalstriatal transplantation, and it was attributed to the interaction between the two therapies. 2 We read with interest the letter by Boyson 3 regarding psychiatric effects of selegiline, and we want to share our experience with two patients in support of the occurrence of manic episodes as an adverse response to selegiline treatment. Report of Cases. —Case 1. —A 62-year-old woman with Parkinson's disease of several years' duration was being treated with carbidopa/levodopa, bromocriptine, trihexyphenadyl, and nortriptyline. Selegiline was added to treat wearing-off phenomena, beginning with 5 mg daily and increasing to 5 mg twice daily. Within 7