Mania following addition of hydroxytryptophan to monoamine oxidase inhibitor

This case report highlights the risk of nutritional supplements and misinformation obtained from the internet particularly for those on monamine oxdiase inhibitors (MAOIs). Despite sophisticated medical knowledge, this patient, who was taking an MOAI and complying with a tyramine-free diet, used a supplement of hydroxytryptophan that along with the MAOI appears to have precipitated mania, despite no personal or familial history of bipolar disorder.