Does Naltrexone Cause Mania?

Naltrexone is an opioid antagonist medication that is commonly used to treat alcohol use disorder and opioid use disorder. Mania from naltrexone is not a common side effect. Naltrexone is also sold under Vivitrol (naltrexone injections), Revia (naltrexone tablets), and Depade (naltrexone tablets).

Mania, or manic episodes, with naltrexone use has been reported in a small number of people with a history of major depression or bipolar disorder.

Learn more about the side effects of taking Naltrexone

Naltrexone And Bipolar Disorder

Naltrexone is a medication that can affect the levels of dopamine and serotonin, two neurochemicals, in the brain. However, it’s not believed to commonly induce mania. Manic episodes are a common feature of bipolar disorder, formerly known as manic depression. This type of disorder commonly co-occurs with substance use disorders.

Mania may occur as a rare but serious side effect of various medications, including some antidepressants, steroids, and stimulants.

Can Naltrexone Treat Bipolar Disorder?

Naltrexone has been studied for its potential use for treating mood disorders like bipolar depression. However, this is not one of its primary uses. Some research indicates that naltrexone may help stabilize mood in people with bipolar disorder. However, additional research has disputed this.

Bipolar disorder, and symptoms of mania, are primarily treated through the use of other pharmacological and behavioral treatments, such as behavioral therapy.

Signs Of Mania While Taking Naltrexone

Mania is a symptom of certain mental health disorders and can be a rare side effect of certain prescription and illicit drugs.

Signs of mania might include:

• unusually elevated mood
• sleeping very little or not at all
• talking very fast
• easily distracted
• very high level of energy
• impulsive or reckless behavior
• rapid and intense mood swings
• grandiosity
• extreme agitation or irritability

Mania can manifest in a number of different ways. This state of mind is associated with an increased risk for suicide, accidents, and unsafe sexual activity.

Is Mania A Common Side Effect Of Naltrexone?

Mania is not a common side effect of naltrexone. If a person does show signs of mania after taking naltrexone, contact the prescribing physician as soon as possible.

Risk Factors For Mania While Taking Naltrexone

Certain factors may increase the risk of experiencing a manic episode after taking naltrexone for a drug or alcohol use disorder.

Risk factors may include:

• history of mania
• personal or family history of mental illness
• taking a high dose of naltrexone
• history of chronic substance abuse
• drug or alcohol abuse
• periods of high stress

Naltrexone-induced mania is not common. If manic episodes do occur during naltrexone treatment, a doctor may recommend a thorough psychological and physical assessment.

What To Do If You Experience Mania On Naltrexone

If you notice signs of mania or unusual mood changes while taking naltrexone, it’s important to act quickly to protect your health and safety. Don’t ignore symptoms or assume they will go away on their own, as untreated mania can lead to dangerous behaviors and serious consequences.

Immediate steps to take:

• Contact your prescribing doctor right away to report your symptoms, including when they started and how severe they are.
• Do not stop taking naltrexone suddenly without medical guidance, as this could complicate your addiction treatment.
• Avoid making major decisions or engaging in risky behaviors until you’ve been evaluated by a healthcare professional.
• Ask a trusted family member or friend to stay with you if your symptoms are severe or if you’re feeling out of control.
• Seek emergency medical care if you experience thoughts of self-harm, severe agitation, or behaviors that put you or others at risk.

Your doctor will likely conduct an evaluation to determine whether naltrexone is causing your symptoms or if they’re related to an underlying mental health condition. They may adjust your naltrexone dose, switch you to a different medication for addiction treatment, or add a mood stabilizer to help manage manic symptoms.

Alternative Medications For Opioid And Alcohol Use Disorders

For opioid use disorder, buprenorphine (Suboxone, Subutex) and methadone are both highly effective maintenance medications that reduce cravings and withdrawal symptoms without causing the euphoria of full opioid agonists. These medications work differently than naltrexone and may be safer for people with bipolar disorder or a history of mania. Methadone is dispensed daily at specialized clinics, while buprenorphine can often be prescribed in a doctor’s office for at-home use.

For alcohol use disorder, acamprosate (Campral) and disulfiram (Antabuse) offer different approaches to supporting sobriety. Acamprosate helps restore brain chemistry balance disrupted by chronic alcohol use and reduces cravings, while disulfiram creates unpleasant reactions when alcohol is consumed, serving as a deterrent. Both medications have different side effect profiles than naltrexone and may be appropriate alternatives if you cannot tolerate naltrexone.

Written by the Addiction Resource Editorial Staff