Side Effects after Phototherapy Implementation in Addition to Fluoxetine or Sertraline Treatment: A Report of Two Cases

Święcicki, Łukasz; Szafrański, Tomasz

doi:10.3109/15622970209150610

Cited by 7 publications

(5 citation statements)

References 15 publications

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“…In a study of 42 patients with nonseasonal MDD, 142 light therapy (5,000 lux, 2 hours, early evening) added to trimipramine 200 mg/day increased sedation, restlessness, sleep disturbances, and vertigo, with decreased appetite. There is a report 143 of two patients using serotonergic drugs (fluoxetine 20 mg/day, sertraline 150 mg/day) who showed emergent symptoms suggestive of the serotonin syndrome 3-5 days after beginning light therapy (10,000 lux, 30 minutes), with diarrhea, nausea, hyperthermia, agitation, and disorientation.…”

Section: Side Effectsmentioning

confidence: 99%

Light Therapy for Seasonal and Nonseasonal Depression: Efficacy, Protocol, Safety, and Side Effects

Terman¹,

2005

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Bright light therapy for seasonal affective disorder (SAD) has been investigated and applied for over 20 years. Physicians and clinicians are increasingly confident that bright light therapy is a potent, specifically active, nonpharmaceutical treatment modality. Indeed, the domain of light treatment is moving beyond SAD, to nonseasonal depression (unipolar and bipolar), seasonal flare-ups of bulimia nervosa, circadian sleep phase disorders, and more. Light therapy is simple to deliver to outpatients and inpatients alike, although the optimum dosing of light and treatment time of day requires individual adjustment. The side-effect profile is favorable in comparison with medications, although the clinician must remain vigilant about emergent hypomania and autonomic hyperactivation, especially during the first few days of treatment. Importantly, light therapy provides a compatible adjunct to antidepressant medication, which can result in accelerated improvement and fewer residual symptoms.

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Section: Side Effectsmentioning

confidence: 99%

Light Therapy for Seasonal and Nonseasonal Depression: Efficacy, Protocol, Safety, and Side Effects

Terman¹,

2005

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“…People with pre-existing retinitis pigmentosa or macular degeneration are advised to have an opthalmological examination before treatment, although there are no known cases of opthalmological damage attributable to light therapy. There is, however, one recent report (Swiecicki & Szafranski, 2002) of possible serotonin syndrome when used in tandem with SSRIs.…”

Section: Side-effects Of Light Therapymentioning

confidence: 99%

Light therapy and the management of winter depression

Eagles¹

2004

Adv. psychiatr. treat

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Much the most common type of seasonal affective disorder at temperate latitudes is recurrent winter depression, which probably affects around 3% of adults in the UK to a clinically significant degree. In this article, diagnosis and presentation are discussed and symptoms are contrasted with those of nonseasonal depression. Aetiology and epidemiology, with regard to age, gender and latitude of residence, are described. Sufferers are often treated with light therapy, and this is described in some detail, with mention of effectiveness, prediction of outcome, timescales of response, side-effects, use of lightboxes and alternatives to lightboxes. Other general aspects of the management of seasonal affective disorder, including the use of antidepressant medication, are also outlined.John Eagles is a consultant psychiatrist at Royal Cornhill Hospital (Cornhill Road, Aberdeen AB25 2ZH, UK) and an honorary reader in mental health at the University of Aberdeen. He has been assessing and treating patients with seasonal affective disorder for 10 years. His other research interests include eating disorders and suicide.

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“…18 Second, in search of a possible implication of phototherapy to which our patient was subjected before the SIADH became obvious, we read about the hitherto unreported occurrence of a typical acute serotonin syndrome in 2 SSRI-treated adult patients with seasonal affective disorder after the introduction of phototherapy. 19 The serotonergic symptoms resolved completely after light therapy was discontinued. The important role of serotonin in the mechanism of light treatment in seasonal affective disorder is demonstrated by the finding that the therapy's beneficial effect can be reversed by lowering the serotonin precursor tryptophan.…”

Section: Discussionmentioning

confidence: 99%

Phototherapy-Mediated Syndrome of Inappropriate Secretion of Antidiuretic Hormone in an In Utero Selective Serotonin Reuptake Inhibitor–Exposed Newborn Infant

et al. 2005

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ABSTRACT. Although selective serotonin reuptake inhibitors (SSRIs) have gained wide acceptance in the offlabel treatment of mental disorders in pregnant women, there seems to be an increased risk for serotonergic adverse effects in newborn infants who are exposed to SSRIs during late pregnancy. Hyponatremia as a result of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a relatively common serious side effect of the use of SSRIs in (mostly elderly) adults. Severe hyponatremia as a result of an SIADH is proposed here as part of a neonatal serotonin toxicity syndrome in a newborn infant who was exposed prenatally to an SSRI. The definite reversal to normal serum sodium levels after fluid restriction, the lack of any alternative cause for the SIADH, and the positive temporal relation with a high score on a widely used adverse drug reaction probability scale offer solid support for the hypothesis of a causal relationship between the SIADH and the prenatal sertraline exposure in our neonate. Moreover, accumulative data on the acute enhancement of serotonergic transmission by intense illumination led us to hypothesize that phototherapy used to treat hyperbilirubinemia in the newborn infant could have been the ultimate environmental trigger for this proposed new cause of iatrogenic neonatal SIADH. The speculative role of phototherapy as a physical trigger for this drug-related adverse event should be confirmed in other cases by thorough study of the serotonin metabolism, assay of SSRI levels in cord blood, and serial measurement of plasma levels in exposed neonates. As phototherapy is used frequently in jaundiced neonates and an apparently increasing number of infants are born to mothers who take SSRIs, serotonin toxicity in neonates deserves increased attention. ABBREVIATIONS. SSRI, selective serotonin reuptake inhibitor; SIADH, syndrome of inappropriate secretion of antidiuretic hormone; CNS, central nervous system; 5-HT, 5-hydroxytryptamine; 5-HIAA, 5-hydroxyindoleacetic acid. S everal authors have reported on neonatal serotonin toxicity syndrome after prenatal exposure to a selective serotonin reuptake inhibitor (SSRI) antidepressant. 1-3 Hyponatremia as a result of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a well-known side effect of SSRIs administered to adults. 4,5 Moreover, there is increasing evidence in the literature for the acute enhancement of cerebral serotonergic transmission by light therapy. [6][7][8] On the basis of these converging facts, we hypothesize that phototherapy could have been the ultimate physical trigger for severe hyponatremia in a neonate who was exposed in utero to an SSRI-type antidepressant drug. CASE REPORTA 32-year-old insulin-dependent diabetic primipara woman used sertraline 50 mg twice daily during the last 3 weeks of pregnancy. Despite ␤-mimetic tocolysis as a result of preterm labor, a girl was born vaginally at 31 weeks of gestation. Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. Because of respiratory di...

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Side Effects after Phototherapy Implementation in Addition to Fluoxetine or Sertraline Treatment: A Report of Two Cases

Cited by 7 publications

References 15 publications

Light Therapy for Seasonal and Nonseasonal Depression: Efficacy, Protocol, Safety, and Side Effects

Light Therapy for Seasonal and Nonseasonal Depression: Efficacy, Protocol, Safety, and Side Effects

Light therapy and the management of winter depression

Phototherapy-Mediated Syndrome of Inappropriate Secretion of Antidiuretic Hormone in an In Utero Selective Serotonin Reuptake Inhibitor–Exposed Newborn Infant

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