Severe agitation in depression precipitated by dasatinib

Area of Science:

• Hematology
• Neuroscience
• Psychiatry

Background:

• Chronic myeloid leukemia (CML) is often treated with tyrosine kinase inhibitors (TKIs).
• Some patients experience severe side effects from TKIs, necessitating treatment changes.
• Neuropsychiatric complications associated with TKI therapy are increasingly recognized.

Observation:

• A CML patient achieved remission with dasatinib but developed severe agitation, insomnia, and motor restlessness.
• These neuropsychiatric symptoms led to a significant zopiclone overdose.
• The patient's symptoms rapidly improved upon initiation of clonazepam, venlafaxine, and mirtazapine therapy.

Findings:

• Dasatinib therapy, while effective for CML, can precipitate serious neuropsychiatric adverse events.
• A combination of clonazepam, venlafaxine, and mirtazapine can effectively manage TKI-induced agitation and insomnia.
• Differential diagnosis and literature review highlight the spectrum of TKI-related neuropsychiatric complications.

Implications:

• This case underscores the importance of monitoring for and managing neuropsychiatric side effects in patients receiving TKIs.
• Prompt and appropriate psychopharmacological intervention is crucial for patient safety and treatment adherence.
• Referral to specialist mental health teams is recommended for complex cases of TKI-associated agitation.