We observed a case of withdrawal after abrupt discontinuation of mianserin. A 41‐year‐old woman was treated according to a diagnosis of depression, which was her 6th episode. Mianserin 30 mg/day, etizolam 1 mg/day and flunitrazepam 1 mg/day were administered. When the patient discontinued taking the drugs by herself because of subsiding of these symptoms, severe panic anxiety appeared. This panic anxiety was not relieved by taking etizolam and flunitrazepam again, but subsided rapidly by the re‐administration of mianserin 30 mg/day, and because of that the depressive symptom also disappeared.
From these experiences panic anxiety seemed to be a withdrawal symptom, and involvement of the noradrenergic system in panic anxiety as well as serotonergic system was suggested.
We have had experience in treating tardive Tourette‐like syndrome on a chronic schizophrenic patient. The patient was a 38‐year‐old woman. A diagnosis of schizophrenia was made in 1971 and she received repeated medications for 17 years. In 1989, she began to show vocal tic with coprolalia and motor tic. The medications were haloperidol 18 mg, zotepine 200 mg, levomepromseine 100 mg, biperiden 3 mg and nitrazepam 10 mg at the beginning of Tourette‐like syndrome. We have tried to change the medications but this tardive Tourette‐like syndrome continued to hang on. However, the symptoms gradually improved after a change in drugs; cessation of biperiden 3 mg and the administration of clonazepam 3 mg. The present case suggested that tardive Tourette‐like syndrome might be a subtype of neuroleptic‐associated tardive syndromes which might be treated with clonazepam.
We have had experience in treating two patients with parkinsonism of which the first manifestation was depression. Case 1 was a 61‐year‐old woman. A diagnosis of depression had been made and repeated medication consisting mainly of antidepressants was given. However, the depressive state persisted and the signs of parkinsonism gradually became evident. The initial treatment with antidepressant drugs was replaced with one based on L‐DOPA (400 mg a day).
Subsequently, the symptoms of parkinsonism and depression diminished relatively rapidly.
Case 2 was a 66‐year‐old man. His parkinsonism was suspected shortly after the onset, although the symptoms of depression were predominant. Similarly, the treatment based on L‐DOPA (400 mg a day) relieved the symptoms of depression and parkinsonism rapidly.
The present study described above indicates that parkinsonism should be suspected in cases of persistent depression and in patients who have depressive symptoms resistant to antidepressants, since parkinsonism may first manifest itself as depression.
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