Ng Qin Xiang, Yong Christl Suet Kwan, Loke Wayren, Yeo Wee Song, Soh Alex Yu Sen
Institute of Mental Health, Buangkok Green Medical Park, Singapore 539747, Singapore.
MOH Holdings Pte Ltd, Singapore 099253, Singapore.
World J Hepatol. 2019 Oct 27;11(10):719-724. doi: 10.4254/wjh.v11.i10.719.
Depression is a growing public health problem that affects over 350 million people globally and accounts for approximately 7.5% of healthy years lost due to disability. Escitalopram, one of the first-line medications for the treatment of depression, is a selective serotonin reuptake inhibitor and one of the most commonly prescribed antidepressant medications worldwide. Although thought to be generally safe and with minimal drug-drug interactions, we herein present an unusual case of cholestatic liver injury, likely secondary to escitalopram initiation.
A 56-year-old Chinese lady presented with fever and cholestatic liver injury two weeks after initiation of escitalopram for the treatment of psychotic depression. Physical examination was unremarkable. Further investigations, including a computed tomography scan of the abdomen and pelvis and tests for hepatitis A, B and C and for autoimmune liver disease were unyielding. Hence, a diagnosis of escitalopram-induced liver injury was made. Upon stopping escitalopram, repeat liver function tests showed downtrending liver enzymes with eventual normalization of serum aspartate aminotransferase and alanine aminotransferase one-week post-discharge.
Clinicians should be aware of the possibility of escitalopram-induced liver injury when initiating depressed patients on antidepressant treatment. This requires extra vigilance as most patients may remain asymptomatic. Measurement of liver function tests could be considered after initiation of antidepressant treatment, especially in patients with pre-existing liver disease.
抑郁症是一个日益严重的公共卫生问题，全球有超过3.5亿人受其影响，约占因残疾导致的健康寿命损失的7.5%。艾司西酞普兰是治疗抑郁症的一线药物之一，是一种选择性5-羟色胺再摄取抑制剂，也是全球最常用的抗抑郁药物之一。尽管通常被认为是安全的，药物相互作用极少，但我们在此报告一例罕见的胆汁淤积性肝损伤病例，可能继发于开始使用艾司西酞普兰之后。
一名56岁的中国女性在开始使用艾司西酞普兰治疗精神病性抑郁症两周后出现发热和胆汁淤积性肝损伤。体格检查无异常。进一步检查，包括腹部和盆腔的计算机断层扫描以及甲型、乙型和丙型肝炎及自身免疫性肝病检测，均无结果。因此，诊断为艾司西酞普兰所致肝损伤。停用艾司西酞普兰后，重复肝功能检查显示肝酶呈下降趋势，出院一周后血清天冬氨酸氨基转移酶和丙氨酸氨基转移酶最终恢复正常。
临床医生在开始对抑郁症患者进行抗抑郁治疗时应意识到艾司西酞普兰所致肝损伤的可能性。这需要格外警惕，因为大多数患者可能没有症状。在开始抗抑郁治疗后，尤其是对已有肝病的患者，可考虑检测肝功能。
