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 use." 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 803285141 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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