Homola Jaclyn, Hieber Robin
Psychiatry Pharmacy Resident, Captain James A. Lovell Federal Health Care Center, North Chicago, Illinois,
Psychiatric Pharmacist and Residency Director, Captain James A. Lovell Federal Health Care Center, North Chicago, Illinois.
Ment Health Clin. 2018 Mar 26;8(2):95-99. doi: 10.9740/mhc.2018.03.095. eCollection 2018 Mar.
Various publications have noted increases in dopamine, specifically in the mesolimbic region of the brain, to have a direct correlation to psychotic-like symptoms. Venlafaxine, a first-line medication for depression, inhibits the reuptake of both serotonin and norepinephrine. Additionally, venlafaxine weakly inhibits the reuptake of dopamine. Phentermine/topiramate (Qsymia®), specifically the phentermine component, functions by blocking the dopamine and norepinephrine transporter, similar to amphetamine.
A 40-year-old Hispanic woman was admitted to the inpatient mental health unit based on reports of delusional thinking and several attempts of self-harm. Past medical history was significant for major depressive disorder, posttraumatic stress disorder, anxiety, irritable bowel syndrome, and migraines. The patient was started on venlafaxine (75 mg extended-release by mouth once daily) for depression approximately 1 month prior to admission. Furthermore, the patient was restarted on a previously prescribed medication, oral phentermine/topiramate for weight loss, in combination with venlafaxine, approximately 1 week prior to the bizarre behavior. The patient denied any psychosis or changes in behavior when medications were taken individually prior to the combination. The patient was treated with lurasidone (40 mg by mouth daily) with resolution of psychosis.
A PubMed search revealed no current literature or case reports on psychosis induced by the combination of venlafaxine and phentermine/topiramate. Individual case reports of psychosis in patients on venlafaxine alone and the phentermine component of phentermine/topiramate alone have been reported.
各种出版物都指出，多巴胺的增加，特别是在大脑的中脑边缘区域，与类精神病症状有直接关联。文拉法辛是治疗抑郁症的一线药物，可抑制血清素和去甲肾上腺素的再摄取。此外，文拉法辛还能微弱地抑制多巴胺的再摄取。苯丁胺/托吡酯（Qsymia®），特别是其中的苯丁胺成分，其作用机制是阻断多巴胺和去甲肾上腺素转运体，类似于苯丙胺。
一名40岁的西班牙裔女性因存在妄想思维和多次自残行为而入住住院精神科病房。既往病史包括重度抑郁症、创伤后应激障碍、焦虑症、肠易激综合征和偏头痛。患者在入院前约1个月开始服用文拉法辛（75毫克缓释片，每日口服一次）治疗抑郁症。此外，患者在出现怪异行为前约1周重新开始服用之前开具的用于减肥的口服苯丁胺/托吡酯，并与文拉法辛联合使用。患者否认在联合用药前单独服用药物时出现任何精神病症状或行为改变。患者接受了鲁拉西酮（每日口服40毫克）治疗，精神病症状得以缓解。
PubMed搜索显示，目前没有关于文拉法辛和苯丁胺/托吡酯联合使用导致精神病的文献或病例报告。已有单独使用文拉法辛以及单独使用苯丁胺/托吡酯中的苯丁胺成分导致患者出现精神病的个别病例报告。
