Case report of anti-N-methyl-D-aspartate receptor encephalitis in a middle-aged woman with a long history of major depressive disorder

Abstract

BackgroundAnti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disease involving antibodies against the NR1 subunits of NMDARs. The disease shows variable clinical presentation, and involves new-onset acute psychotic symptoms, making it difficult to differentiate from major depressive disorder with psychotic symptoms. Potential associations between this autoimmune disorder and onset or progression of major depressive disorder remains unclear.Case presentationWe present a rare case of a patient who had both major depressive disorder and anti-NMDAR encephalitis and in whom the encephalitis initially went undetected. The patient had been suffering from depressive disorder for more than 6 years without any treatment, when she was hospitalized for new-onset psychotic symptoms. She was initially diagnosed only with major depressive disorder with psychotic symptoms, but antipsychotics did not alleviate symptoms and the patient’s psychiatric course began to fluctuate rapidly. Anti-NR1 IgG autoantibodies were detected in cerebrospinal fluid, and the combination of immunotherapy and antipsychotics proved more effective than antipsychotics alone. The patient was then also diagnosed with anti-NMDAR encephalitis.ConclusionsOur case suggests that clinicians should consider anti-NMDAR encephalitis when a patient with depressive disorder shows sudden fluctuations in psychiatric symptoms. It also highlights the need for research into possible relationships between anti-NMDAR encephalitis and major depressive disorder.

Case Report: Severe Adolescent Major Depressive Syndrome Turns Out to Be an Unusual Case of Anti-NMDA Receptor Encephalitis

“…Here we present the third published case of anti-NMDA receptor encephalitis, which resembles a major depression without any initial neurological signs or symptoms. In contrast to the other two cases, a 16-year-old girl ( 15 ) and a 52-year-old woman ( 16 ), our patient did not show any distinct concomitant psychotic symptoms, other than some attenuated positive symptoms and basic symptoms according to a sensitive early recognition scale for psychosis, ERIraos. Although the clinical presentation was dominated by core symptoms of depression and familiar features like preceding psychosocial stress factors (break up of a relation, graduation year), there were also some apparent atypical aspects.…”

“…Notably, the psychopathology of those cases is dominated by psychotic, cognitive, and catatonic symptoms (12)(13)(14). To our knowledge, there are only two case reports in the literature of anti-NMDAR encephalitis, which mimic a major depressive episode with psychotic symptoms (15,16). Here we report the first case of a patient with anti-NMDAR encephalitis, which presents as a major depressive episode without distinct psychotic symptoms like delusion, hallucination, or catatonia, as well as without any neurological signs or symptoms.…”

Anti-NMDA Encephalitis: A Rare Encephalitis in a Child- A Case Report

“…Anti NMDA receptor encephalitis is autoimmune disorder first described by Dalmau and colleagues in 2007 among 12 women as paraneoplastic condition. 2 It is a rare disorder with very low incidence and the prevalence in children is exactly unknown. Remy KE et al reported more than 600 cases including paediatric ones and Goldberg EM reported 577 cases with 37% children.…”

“…Anti N-Methyl-D-Aspartate Receptor (NMDAR) encephalitis is a synaptic autoimmune condition. 1,2 It is considered second commonest cause of autoimmune encephalitis after acute disseminated e n c e p h a l o m y e l i t i s a m o n g c h i l d r e n a n d adolescents. 1 It is more common among females during adolescence and among males in children younger than 12 years.…”

Algo más que monoaminas en el tratamiento de la depresión: Mecanismos neurobiológicos emergentes de los antidepresivos del siglo XXI

“…Los receptores NMDA tienen una clara relación fisiopatológica y terapéutica con la depresión. Así, la encefalitis provocada por anticuerpos anti R-NMDA se caracteriza por un trastorno depresivo mayor [95]. Además, en estudios postmortem de pacientes deprimidos, se ha podido detectar un aumento significativo de la subunidad NR2C de R-NMDA en el locus coeruleus [88] y una reducción de las subunidades NR2A (54%) y NR2B (48%) del receptor NMDA en corteza prefrontal [84], junto a un aumento de la subunidad NR2A en la amígdala de los sujetos deprimidos vs. controles [96].…”