Red kratom and red corvette: A case of mania induced by kratom withdrawal

Background: Kratom, derived from the Mitragyna speciose, a plant native to Southeast Asia, is a substance that is gaining popularity in the United States as a self-medication tool for opiate withdrawal and pain management. Its active compounds, mitragynine, and 7-hydroxymitragynine, interact with various receptors in the body, resulting in a spectrum of clinical effects. Case: A 56-year-old male with a history of depression and cannabis use disorder arrived at the Emergency Department in a state of severe agitation with erratic behavior and aggression. Further evaluation revealed a recent abrupt discontinuation of Kratom use. A psychiatric consultation was requested and done by our consultation-liaison team, diagnosing Kratom withdrawal as the most likely cause of his acute mania. Neuropsychiatric symptoms arising from Kratom toxicity is a well-documented phenomenon; however, to our knowledge, this may be the first documented case of acute mania induced by Kratom withdrawal.