Reactions 1246 - 4 Apr 2009

SCitalopram

Behavioural disinhibition: case reportA 33-year-old man developed behavioural disinhibition

after starting citalopram for chronic depression.The man had a 2-year history of chronic depression and

had shown a partial response to paroxetine. Citalopramwas started at 20 mg/day and gradually titrated to60 mg/day over a 12-week period. He achieved a partialresponse and for 3 months he appeared normothymic atmonthly follow-up visits. However, his fatigue, socialisolation, loss of interest and pleasure continued. His wifereported a pattern of excessive shopping over recentweeks, and displays of irritability on being questionedabout his whereabouts and spending [time to reactiononset not clearly stated]. A psychiatric evaluation over thisperiod of behavioural disinhibition did not find evidencesuggestive of persistent hypomanic mood and cross-sectional mental status examination did not showpressured speech, flight of ideas or grandiosity. He did notmeet DSM-IV criteria for hypomania or mania.

The man’s citalopram dosage was reduced to 20 mg/dayover 1 week and his out of character behaviour disappearedover 2–3 weeks.

Author comment: "[A]ntidepressant-associated hypomaniamay also be predominantly manifested with behaviouralchanges rather than with hypomanic moods".Rocha FF, et al. Behavioral disinhibition without persistent mood elevation afterhigh dose citalopram treatment. Revista Brasileira de Psiquiatria 29: 384-385, No.4, Dec 2007 - Brazil 801132365

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Reactions 4 Apr 2009 No. 12460114-9954/10/1246-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved