summary A 37-year old woman presented with a manic syndrome, after a period in which she deliberately had lost considerable weight. Because she had a history of depressive disorder and was currently treated with amitriptyline, the diagnosis of bipolar disorder was initially made. She was treated on a psychiatric ward with lithiumcarbonate. After a good length of time after discharge we were incidentally informed on her daily use in the weeks before admission of a ephedrine-containing herbal supplement for weight loss. There is some literature reporting cases of ephedrine-induced mania, but no earlier reports were found on the interaction of ephedrine and amitriptyline.