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Published on: March 2, 2015
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Agitated Depression Associated With Flurazepam Discontinuation
Mohamed Salih1, Reem Mohamed Osman2, Wala Alim3
1St Davne'ts Campus Cavan Monaghan Mental Health Service, Rooskey, Monaghan, Ireland.
Case Reports in Psychiatry
|September 30, 2024
Summary
Agitated depression, a severe form of melancholia agitata, can worsen with antidepressants. This case highlights successful treatment with GABA agonists like alprazolam and zopiclone, alongside olanzapine.
Area of Science:
- Psychiatry
- Neuroscience
Background:
- Agitated depression (melancholia agitata) presents with severe psychomotor agitation, anxiety, and high suicide risk.
- This depression subtype may worsen with antidepressants and improve with treatments like ECT, lithium, antiepileptics, antipsychotics, and benzodiazepines.
Observation:
- A 73-year-old female with a history of depression and anxiety experienced severe agitated depression with psychotic features after discontinuing long-term flurazepam.
- Symptoms persisted despite switching to nitrazepam and temazepam and worsened with antidepressants.
Findings:
- Complete symptom resolution was achieved with a combination of alprazolam, zopiclone, and olanzapine.
- This suggests a potential role for GABA agonists in managing agitated depression, particularly after benzodiazepine discontinuation.
Implications:
- This case offers insights into the pathology and management of agitated depression.
- It underscores the importance of considering GABAergic system involvement and tailored pharmacotherapy for this specific depression variant.
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