Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 9 1 2024 10 22 26 28 Sahar Dadfar Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran Morvarid Ahadi Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran 2024 04 11 2024 06 08 This case report describes a rare occurrence of tramadol misuse resulting in a manic episode in a patient without a history of psychiatric disorders. The patient had used tramadol off-label for premature ejaculation. Following discontinuation of tramadol and initiation of mood stabilizer treatment, the manic symptoms resolved. Tramadol, despite its potential antidepressant properties, also poses a risk of inducing psychiatric disturbances. Diagnosis can be challenging and necessitates a thorough examination. Management involves immediate cessation of tramadol and administration of mood stabilizers. Clinicians should exercise caution and closely monitor patients when prescribing tramadol, particularly for off-label indications. https://crcp.tums.ac.ir/index.php/crcp/article/view/926 https://crcp.tums.ac.ir/index.php/crcp/article/download/926/629