Reactions 1316 - 28 Aug 2010

SCitalopram

Proconvulsant effect: case reportThe following case report describes a proconvulsant

effect associated with citalopram treatment for assumedpanic attacks in a 36-year-old man [duration of treatmentprior to reaction onset not clearly stated].

The man presented with a 1-year history of nocturnalattacks, which involved spasms, sensations of tension andtingling, chest pain and dyspnoea. He had beenexperiencing approximately thirty attacks per night. Hisdoctor had initially suspected a panic disorder andcitalopram 20mg [frequency and route of administrationnot stated] had been initiated. He subsequently improvedwith a fifty percent reduction in the number of attacks.Psychiatric evaluation revealed a preoccupation concerningthe development of a life-threatening disorder. Six weeksafter being diagnosed, the frequency of attacks increased,which necessitated an increase in citalopram to 30mg. Hehad also developed exanthema, double vision, tingling inthe extremities and loss of libido; however, thesesymptoms in addition to his attacks resolved followingdosage elevation with the exception of residual tingling. Hisattacks returned, 2 months later, and soon reached afrequency of up to twenty five attacks per night. He alsostarted experiencing chest pain during the day.Interestingly, his symptoms were reduced after physicalactivity. A further increase in dose to 60mg provedineffective. He was subsequently diagnosed with frontalepilepsy, based on EEG results and clinical observation.

Citalopram was withdrawn and carbamazepine wasinitiated. His nocturnal attacks resolved and the priordiagnosis of panic disorder was ruled out.

Author comment: "Research results demonstrate thatSSRIs can have not only an antidepressive and calming effect,they can also have an anticonvulsant effect. However, thereare also signs that, as this case illustrates, in the long term theanticonvulsant effect can actually convert to proconvulsanteffect."Wanders AJB, et al. Diagnosis of epilepsy complicated by panic disorder and anon-specific reaction to a SSRI. Tijdschrift voor Psychiatrie 52: 349-352, No. 5,2010 [Dutch; summarised from a translation] - Netherlands 803030578

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Reactions 28 Aug 2010 No. 13160114-9954/10/1316-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved