Which of the following is NOT listed as causing mania?

• A. Flonase
• B. Steroids
• C. Disulfiram
• D. ACE inhibitors

Answer: (D)

Mania from medications usually comes from agents that strongly affect brain mood regulation, especially corticosteroids and substances that alter CNS neurotransmission. Steroids are a classic trigger, able to precipitate manic or hypomanic episodes in susceptible individuals due to their impact on stress and neurotransmitter systems. Flonase is a nasal corticosteroid, and while it has minimal systemic effects, high-dose use can occasionally produce mood changes, so it’s not entirely outside the realm of steroid-related mood symptoms. Disulfiram has been reported to cause various neuropsychiatric effects, including agitation and psychosis in some cases, and rarely mania. In contrast, ACE inhibitors do not have mania as a typical or listed adverse effect; their common issues are cough, hyperkalemia, and angioedema, with mood disturbances being uncommon. Therefore, ACE inhibitors are not listed as causing mania.