Acute Psychosis Following Phenelzine Discontinuation

B, Liskin; Roose, Steven P.; Walsh, B. Timothy; Jackson, Wynn

doi:10.1097/00004714-198502000-00010

Cited by 22 publications

(5 citation statements)

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“…The second patient reported upon by Liskin et al (1) was a 21-year-old woman with a five-year history of bulimia. She was treated with phen-elzine 90 mg/day for 4 weeks.…”

Section: Case Reportsmentioning

confidence: 95%

Monoamine oxidase inhibitor withdrawal phenomena: symptoms and pathophysiology

Dilsaver

1988

Acta Psychiatr Scand

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The author reviews the literature reporting the untoward effects of withdrawing monoamine oxidase inhibitors (MAOIs). The withdrawal of these agents can result in severe anxiety, agitation, pressured speech, sleeplessness or drowsiness, hallucinations, delirium and paranoid psychosis. MAOI withdrawal phenomena resemble the symptoms produced by the discontinuation of chronically administered psychostimulants. The capacity of MAOI to exert amphetamine-like effects presynaptically, and the propensity of somatic treatments for depression to subsensitize presynaptic receptors regulating the release of catecholamines, can provide a basis for the development of psychotic syndromes upon the withdrawal of MAOIs. Evidence for this hypothesis is reviewed.

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“…The second patient reported upon by Liskin et al (1) was a 21-year-old woman with a five-year history of bulimia. She was treated with phen-elzine 90 mg/day for 4 weeks.…”

Section: Case Reportsmentioning

confidence: 95%

Monoamine oxidase inhibitor withdrawal phenomena: symptoms and pathophysiology

Dilsaver

1988

Acta Psychiatr Scand

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“…The clinical picture may include: (i) a worsening of depressive symptoms, exceeding the severity of the state that originally led to treatment (Halle & Dilsaver, 1993); (ii) an acute confusional state with disorientation, paranoid delusions and hallucinations (Liskin et al, 1984;Roth, 1985;Halle & Dilsaver, 1993); and (iii) anxiety symptoms, including hyperacusis and depersonalisation (Tyrer, 1984).…”

Section: Maoi Discontinuation Syndromementioning

confidence: 99%

Recognising and managing antidepressant discontinuation symptoms

Haddad¹,

Anderson²

2007

Adv. psychiatr. treat

130

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and an honorary senior lecturer at the University of Manchester. His clinical and research interests include the pharmacological treatment of affective disorders and schizophrenia and the safety and adverse effects of psychotropic medication. He was a member of the Guideline Development Group for the National Institute for Health and Clinical Excellence's guidelines on bipolar disorder (2006 Abstract Antidepressant discontinuation symptoms occur with all classes of antidepressant. A welldescribed discontinuation syndrome occurs with the selective serotonin reuptake inhibitors, common symptoms including dizziness, headache, nausea and lethargy. Rare antidepressant discontinuation syndromes include extrapyramidal syndromes and mania/hypomania. All these syndromes, even isolated discontinuation symptoms, share three common features that facilitate diagnosis; abrupt onset within days of stopping the antidepressant, a short duration when untreated and rapid resolution when the antidepressant is reinstated. Clinicians need to be familiar with strategies for the prevention and management of such symptoms. Preventive strategies include warning patients about the possibility of discontinuation symptoms, encouraging good antidepressant adherence and tapering antidepressants at the end of treatment. Most symptoms are mild and shortlived. Consequently symptoms that follow planned termination of an antidepressant can often be managed by providing an explanation and reassurance. More severe symptoms should be treated symptomatically or the antidepressant restarted, in which case symptoms usually resolve within 24 h. More cautious tapering can then follow.

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“…Phenelzine withdrawal has been noted in multiple previous reports. [10][11][12][13][14] In one previously reported case 13 of phenelzine withdrawal, the patient developed agitation, rapid speech, irritability, insomnia, and confusion 2 days after abruptly discontinuing phenelzine. At that time, the patient also experienced visual, olfactory, auditory, and tactile hallucinations.…”

Section: Discussionmentioning

confidence: 97%

Phenelzine–Opiate–Induced Delirium Complicated by Phenelzine Withdrawal

Gold

Fatemi

2003

Journal of Pharmacy Technology

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Objective: To report a case of delirium involving a drug interaction of the antidepressant phenelzine in combination with an opiate and to discuss the exacerbation of delirium secondary to a withdrawal syndrome caused by the abrupt discontinuation of phenelzine.Case Summary: A 67-year-old white woman with a history of major depression and chronic anxiety developed delirium shortly after the postsurgical administration of opioid analgesics. In addition, she was taking the antidepressant phenelzine and had been maintained on this medication for approximately 20 years. Her presenting symptoms included combativeness, auditory and visual hallucinations, and persecutory delusions. After development of the delirium, the patient's phenelzine medication was abruptly discontinued, introducing a withdrawal syndrome that further aggravated her condition.Discussion: This case emphasizes the importance of the potentially fatal drug interaction involving phenelzine and opiates and addresses the adverse consequences of abruptly discontinuing phenelzine during phenelzine-opiate-induced delirium. Phenelzine-opiate interactions and phenelzine withdrawal should be considered as possible etiologies of delirium in patients with a history of phenelzine use. Conclusions:Less widely prescribed antidepressants such as phenelzine may be unfamiliar to contemporary clinicians, resulting in adverse consequences for patients, such as phenelzine-opiate drug interactions and phenelzine withdrawal.

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Acute Psychosis Following Phenelzine Discontinuation

Cited by 22 publications

References 0 publications

Monoamine oxidase inhibitor withdrawal phenomena: symptoms and pathophysiology

Monoamine oxidase inhibitor withdrawal phenomena: symptoms and pathophysiology

Recognising and managing antidepressant discontinuation symptoms

Phenelzine–Opiate–Induced Delirium Complicated by Phenelzine Withdrawal

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