Reactions 1680, p56 - 2 Dec 2017
Orthostasis: case report
A 54-year-old man developed orthostasis during treatment
with aripiprazole, phenelzine and quetiapine [routes, time to
reaction onset not stated and outcome not stated].
The man was diagnosed with major depression with
psychotic features, which was in partial remission. He received
treatment with clomipramine augmented with quetiapine up
to 1200 mg/day. No significant symptomatic response was
observed. Aripiprazole up to 15 mg/day was started as an
adjunctive therapy on 23 January 2015. Only modest benefit
was observed with aripiprazole. Consequently, therapy with
phenelzine 15mg every morning was initiated on
10 April 2015. The treatment also included aripiprazole and
quetiapine 1000 mg/day. The dose of quetiapine was gradually
reduced to 300mg at bedtime due to the risk of orthostasis.
The doses of phenelzine and aripiprazole were steadily
increased. In June 2015, he was on aripiprazole 20 mg/day,
quetiapine 300mg at bedtime and phenelzine 30mg thrice a
day. A significant antidepressant response was achieved.
Subsequently, he had complaints of orthostasis.
The man’s therapy with phenelzine was discontinued on
09 September 2015 as a result of falls. Later, levomilnacipran
was added to the therapy, but failed.
Author comment: "While the combination of an atypical
antipsychotic and [MAO inhibitors] may carry a risk of
orthostasis in middle-aged and older patients, concerns about
[serotonin syndrome] should not be the factor preventing its
Meyer JM, et al. Augmentation of phenelzine with aripiprazole and quetiapine in a
treatment-resistant patient with psychotic unipolar depression: Case report and
literature review. CNS Spectrums 22: 391-396, No. 5, Oct 2017. Available from:
URL: http://doi.org/10.1017/S1092852916000821 - USA
Reactions 2 Dec 2017 No. 16800114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved