0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

1
Letters   |    
Tetrabenazine and Suicidal Ideation
Lokesh Shahani, M.D.
The Journal of Neuropsychiatry and Clinical Neurosciences 2013;25:E30-E30. doi:10.1176/appi.neuropsych.12020033
View Author and Article Information

Dept. of Internal Medicine SIU School of Medicine Springfield, IL

Correspondence: Lokesh Shahani, M.D.; e-mail: lokesh83@hotmail.com

Copyright © 2013 American Psychiatric Association

To the Editor: Huntington's disease (HD) is an inherited progressive neurodegenerative disorder associated with choreiform movements, psychiatric problems, and dementia. Chorea is a key feature and most times the symptom leading to the diagnosis of the disease. Chorea could also be associated with functional impairment and warrants treatment. Most commonly, it can be treated with various pharmacological measures, including typical and atypical neuroleptics, and monoamine-depleting agent such as tetrabenazine.

We report on a 52-year-old Caucasian woman presenting to the emergency department with worsening depression for the past week and new-onset suicidal ideation. Patient had a history of depression diagnosed 7 years ago and which had been under remission for the past 2 years. She was on fluoxetine 40 mg daily and mentioned good medication compliance. The patient was diagnosed with HD 3 years ago after insidious onset of chorea in the facial area and the upper extremities. The patient had been started on tetrabenazine 2 weeks ago. She was started on 12.5 mg for the first week and was later increased to 12.5 mg twice a day in the second week. The patient’s affective worsening lacked any psychosocial stressors, and she could temporally relate her condition to the addition of tetrabenazine. Fluoxetine was increased to 60 mg a day, and the patient was discharged from the emergency department with a safety plan and follow-up at the outpatient clinic. Two weeks later her depression has responded to the increase in fluoxetine, and she denied any suicidal ideations. She was continued at the same dose of tetrabenazine and follow-up at the outpatient psychiatry clinic.

Tetrabenazine acts as an inhibitor of vesicular monoamine transporter-2, leading to depletion of central dopamine, norepinephrine, and serotonin.1 Considering this mechanism of action, depression has been associated as an adverse reaction to the medication. Depression has been associated with 15% of the patients treated with this medication and seems more likely in patient with a pre-existing history of depression.2 Suicide among patients on tetrabenazine has also been reported.3,4 Fortunately, this particular medication-induced depression has been shown to respond to antidepressants.5 Hence, close follow-up and special attention to patients with a pre-existing history of depression after prescribing tetrabenazine is warranted.

Roberts  MS;  McLean  S;  Millingen  KS  et al. The pharmacokinetics of tetrabenazine and its hydroxyl metabolite in patients treated for involuntary movement disorders. Eur J Clin Pharmacol 1986; 29:703Y708
 
Kenney  C;  Hunter  C;  Mejia  N  et al:  Is history of depression a contraindication to treatment with tetrabenazine? Clin Neuropharmacol 2006; 29:259–264
[CrossRef] | [PubMed]
 
Huntington Study Group. Tetrabenazine as antichorea therapy in Huntington disease: a randomized controlled trial. Neurology 2006; 66:366Y372
 
Gimenez-Roldan  S;  Mateo  D. Huntington disease: tetrabenazine compared to haloperidol in the reduction of involuntary movements. Neurologia 1989; 4:282Y287
 
Soutar  CA:  Tetrabenazine for Huntington’s chorea.  BMJ 1970; 4:55
[CrossRef] | [PubMed]
 
References Container
+

References

Roberts  MS;  McLean  S;  Millingen  KS  et al. The pharmacokinetics of tetrabenazine and its hydroxyl metabolite in patients treated for involuntary movement disorders. Eur J Clin Pharmacol 1986; 29:703Y708
 
Kenney  C;  Hunter  C;  Mejia  N  et al:  Is history of depression a contraindication to treatment with tetrabenazine? Clin Neuropharmacol 2006; 29:259–264
[CrossRef] | [PubMed]
 
Huntington Study Group. Tetrabenazine as antichorea therapy in Huntington disease: a randomized controlled trial. Neurology 2006; 66:366Y372
 
Gimenez-Roldan  S;  Mateo  D. Huntington disease: tetrabenazine compared to haloperidol in the reduction of involuntary movements. Neurologia 1989; 4:282Y287
 
Soutar  CA:  Tetrabenazine for Huntington’s chorea.  BMJ 1970; 4:55
[CrossRef] | [PubMed]
 
References Container
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Books
The American Psychiatric Publishing Textbook of Psychiatry, 5th Edition > Chapter 3.  >
The American Psychiatric Publishing Textbook of Psychiatry, 5th Edition > Chapter 43.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 1.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 53.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 53.  >
Topic Collections
Psychiatric News
APA Guidelines
PubMed Articles