Department of Psychiatry, Walter Reed National Military Medical Center, Bethesda, MD.
Department of Medicine-Cardiology, Uniformed Services University of the Health Sciences, Bethesda, MD.
Mayo Clin Proc. 2014 Nov;89(11):1584-7. doi: 10.1016/j.mayocp.2014.08.010. Epub 2014 Nov 3.
Brugada syndrome (BrS) is a common occult cause of sudden cardiac arrest in otherwise healthy-appearing adults. The pathognomonic electrocardiographic pattern may be unmasked only by certain medications, many of which are unknown. We report a case of a depressed but otherwise healthy man with an asymptomatic right bundle branch block on electrocardiography who experienced antidepressant-induced BrS and ultimately recovered with transcranial magnetic stimulation (TMS). After an initial trial of nortriptyline, the patient's depressive symptoms improved; however, he experienced a syncopal event and was subsequently diagnosed as having BrS. Cross titration to bupropion, which had not previously been known to exacerbate BrS, was followed by another cardiac event. As a result, the patient was referred for TMS as a substitute for pharmacotherapy. After 31 TMS sessions over 8 weeks, the patient demonstrated significant improvement by subjective report and objective reduction in his Patient Health Questionnaire-9 scores from 10 (moderate) to 1 (minimal). Transcranial magnetic stimulation is a Food and Drug Administration-approved nonpharmacologic treatment for depression. Given the potential lethality of BrS with known and unknown psychopharmacologic agents, providers should consider TMS as first-line therapy in this patient population. Bupropion should be added to the list of agents known to exacerbate this disease.
Brugada 综合征（BrS）是一种常见的隐匿性病因，可导致看似健康的成年人发生心源性猝死。特征性心电图模式可能仅在某些药物的作用下显现，而其中许多药物是未知的。我们报告了一例心电图显示无症状性右束支传导阻滞的抑郁但其他方面健康的男性患者，他经历了抗抑郁药诱发的 BrS，并最终通过经颅磁刺激（TMS）得以恢复。在最初尝试使用去甲替林后，患者的抑郁症状有所改善；然而，他出现了晕厥事件，随后被诊断为患有 BrS。改用先前未知会加重 BrS 的安非他酮进行交叉滴定后，又发生了另一次心脏事件。因此，患者被转介接受 TMS 治疗以替代药物治疗。经过 8 周 31 次 TMS 治疗后，患者通过主观报告和客观降低其患者健康问卷-9 评分（从 10 分[中度]降至 1 分[轻度]）显示出显著改善。经颅磁刺激是一种获得美国食品和药物管理局批准的非药物治疗抑郁症的方法。鉴于已知和未知精神药理学药物可导致 BrS 的潜在致命性，对于此类患者人群，医生应考虑将 TMS 作为一线治疗方法。应将安非他酮添加到已知可加重这种疾病的药物清单中。
