The authors minimized the likelihood that the selective serotonin reuptake inhibitor (SSRI) fluoxetine may have been implicated in the switching process since it was initiated years earlier and the dose was doubled over 4 months before this mood alteration. We take the opposite view, suggesting that fluoxetine may have contributed to the switching process. This opinion is partially based upon recent work by Ramasubbu (3), who described two depressed patients—one with unipolar depression and the other with dysthymia. In both instances, the patient became hypomanic when the SSRI (sertraline and paroxetine, respectively) dose was significantly increased, and the hypomania resolved with subsequent dose reduction. In these cases, the switching occurred approximately 1 month after the dose increase, similar to the case by Dr. Onyike et al., in which mania developed 4 months after the SSRI dose increase.