Reactions 1190 - 23 Feb 2008

SDesipramine/venlafaxine

Manic episode in a patient with brain damage: casereport

A 45-year-old brain-damaged man experienced a manicepisode featuring homicidal ideation, while receivingdesipramine for phantom limb pain, and venlafaxine foranxiety and depression.

The man, who had been been left with cognitive impairmentand an amputated limb after being electrocuted in a workplaceaccident, was treated with desipramine 50mg and 75mg, onalternate days. At higher doses [dosages not stated], he hadexperienced rapid eye movement sleep behaviour disorder.He began to experience anxiety and depression, and21 months after his accident, he was initiated on venlafaxine37.5 mg/day. After 6 months, the venlafaxine dose wasincreased to 75 mg/day. Three months later, he presented witha 2-week history of increasing agitation, anxiety and irritability,nightmares and disturbed sleep. He was having daily panicattacks and reported racing thoughts. He was hospitalised,where he was noted to be angry, and he reported havinghomicidal thoughts. His behaviour was noted to beuncharacteristic.

Venlafaxine was discontinued and the man was initiated onquetiapine. The homicidal ideation gradually disappeared andhis cognitive function improved. He was discharged 9 daysafter admission, and received ongoing psychiatric andpsychological follow-up. His manic symptoms came undercontrol after the desipramine dose was decreased to 50mgdaily, and the quetiapine dose was increased.

Author comment: "The association of venlafaxine anddesipramine likely triggered the manic episode in this patientvulnerable because of prior electrocution and head trauma."Dealberto MJ, et al. Homicidal ideation with intent during a manic episodetriggered by antidepressant medication in a man with brain injury. BipolarDisorders 10: 111-113, No. 1, Feb 2008 - Canada 801100803

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Reactions 23 Feb 2008 No. 11900114-9954/10/1190-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved