Agomelatine/amisulpride/zolpidem

Abstract

Agomelatine/amisulpride/zolpidem Various toxicties: case reportA 42-year-old woman developed parkinsonism, extrapyramidal side effects and amenorrhoea due to hyperprolactinaemia during treatment with amisulpride for schizophrenia and Cotard's syndrome (CS). She felt like a zombie during treatment with agomelatine for major depressive disorder. Additionally, she exhibited lack of efficacy during treatment with agomelatine and zolpidem for major depressive disorder [routes, durations of treatments to reactions onset not stated; not all outcomes stated].The woman in Malaysia presented with various non-specific health ailments. After four years, her overall mental health worsened. Subsequently, a diagnosis of major depressive disorder was confirmed and she received zolpidem 10mg daily and agomelatine 25mg daily. Despite 3 weeks of treatment, her symptoms including insomnia and mental health worsened. She reported that she "felt like a zombie", which was thought to be related to agomelatine. Because of significant physical health worsening, she was admitted to hospital in September 2018. Thereafter, a diagnosis of CS and schizophrenia was made. She demonstrated poor response to risperidone and nihilistic delusions were present while being treated at the hospital. Thereafter, antipsychotic treatment was switched to amisulpride 200mg at night. She demonstrated a marginal improvement though she starting experiencing parkinsonism at the dose of 600mg twice daily.The woman received trihexyphenidyl. Upon discharge, she still had residual symptoms of psychosis. Subsequently, she was readmitted. The extrapyramidal side effects of amisulpride were still there and she reported amenorrhoea because of hyperprolactinaemia, which were also attributed to amisulpride. Hence, a course of electroconvulsive therapy (ECT) was provided. Amisulpride was changed to quetiapine. Subsequently, she demonstrated significant improvement and was discharged following 3 weeks and was advised to take quetiapine. After 3 months, her menstruation returned and prolactin level normalised. No extrapyramidal symptoms were noted.