Cierny Marek, Feemster John, Hamid Mohsin, Battistini Humberto A
Department of Neurology, Medical College of Wisconsin, Milwaukee.
Medical College of Wisconsin-Central Wisconsin, Wausau.
Clin Neuropharmacol. 2023;46(5):198-199. doi: 10.1097/WNF.0000000000000563. Epub 2023 Jul 18.
In persons with narcolepsy type 1, sudden withdrawal of antidepressants can cause status cataplecticus. We describe a 77-year-old female patient with long-standing history of narcolepsy type 1 complaining of recurrent short sudden episodes of whole-body paralysis, with preserved consciousness and memory. Episodes started an hour after her family invited her to celebrate Mother's Day. One week prior, patient had abruptly discontinued duloxetine. Cataplectic episodes resolved within 24 hours after resumption of duloxetine and treatment of hypokalemia. Status cataplecticus has been reported after withdrawal of venlafaxine, fluoxetine, and clomipramine. This is the first report of status cataplecticus due to duloxetine withdrawal. We review the pathophysiology of antidepressant withdrawal-induced status cataplecticus. In persons with narcolepsy type 1, physicians discontinuing any antidepressant should counsel on adverse effects of antidepressant withdrawal and reduce the dose in tapering manner.
在1型发作性睡病患者中，突然停用抗抑郁药可导致猝倒持续状态。我们描述了一名77岁的女性患者，有长期1型发作性睡病病史，主诉反复出现短暂的全身麻痹突发发作，意识和记忆保留。发作在其家人邀请她庆祝母亲节一小时后开始。一周前，患者突然停用了度洛西汀。恢复度洛西汀治疗和低钾血症治疗后，猝倒发作在24小时内缓解。文拉法辛、氟西汀和氯米帕明停药后曾有猝倒持续状态的报道。这是因度洛西汀停药导致猝倒持续状态的首例报道。我们回顾了抗抑郁药撤药所致猝倒持续状态的病理生理学。在1型发作性睡病患者中，停用任何抗抑郁药的医生都应就抗抑郁药撤药的不良反应进行咨询，并以逐渐减量的方式减少剂量。
