Letter to the Editor
Transient global amnesia following abrupt discontinuation of escitalopram
Amnesia global transitoria tras interrupción brusca de un tratamiento con escitalopram
Francisco José Fernández-Fernández
Servicio de Medicina Interna, Complejo Hospitalario Universitario de Ferrol, Ferrol 15405, Spain
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(b) Osmoscan curve showing a flat curve in SAO patient confirming decreased RBC deformability (<span class="elsevierStyleItalic">green</span>: normal patient; <span class="elsevierStyleItalic">orange</span>: patient with South-East Asian ovalocytosis).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Marta Canelo-Vilaseca, Inés Hernández-Rodríguez, José-Tomás Navarro" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Marta" "apellidos" => "Canelo-Vilaseca" ] 1 => array:2 [ "nombre" => "Inés" "apellidos" => "Hernández-Rodríguez" ] 2 => array:2 [ "nombre" => "José-Tomás" "apellidos" => "Navarro" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775323004694?idApp=UINPBA00004N" "url" => "/00257753/0000016200000001/v1_202401010505/S0025775323004694/v1_202401010505/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0025775323004621" "issn" => "00257753" "doi" => "10.1016/j.medcli.2023.07.012" "estado" => "S300" "fechaPublicacion" => "2024-01-12" "aid" => "6388" "copyright" => "Elsevier España, S.L.U." 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In this paper I describe the case of a 53-year-old man who experienced a clinical picture compatible with transient global amnesia after abrupt discontinuation of escitalopram.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 53-year-old man with a history of depression presented to the emergency department complaining of that when he returned home from shopping did not remember what he had done in the previous hours. He had repetitive questioning and was amnestic but oriented to time, place and person. The neurologic examination was normal. The emergency blood tests showed an Hb of 16.9<span class="elsevierStyleHsp" style=""></span>g/dl. Blood levels of glucose and electrolytes were normal, as were the results of liver-function and kidney-function tests. A computed tomography of the brain and the electroencephalogram were normal. He was discharged from the hospital. A magnetic resonance imaging of the brain performed on an outpatient basis showed no alterations. One month later, in the outpatient clinic, he was fine and told us that he had not taken his treatment with escitalopram since 3 days before the episode of amnesia. In follow-up 6 months after the episode, he remains asymptomatic.</p><p id="par0015" class="elsevierStylePara elsevierViewall">TGA may be preceded by a precipitating event, such as an activity associated with a Valsalva maneuver, emotional stress, exposure to extreme temperatures, sexual intercourse, or severe pain.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> TGA is significantly more likely to occur, among other processes, in patients with a history of depression.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The cause of TGA is still unknown. The delayed appearance of unilateral o bilateral punctate DWI/T2 lesions in the hippocampus, on magnetic resonance imaging (MRI) performed many hours after the episode, in a proportion of affected patients, provides support for a vascular etiology.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Selective serotonin reuptake inhibitors have emerged as first-line drugs for treating depressive disorders and patients with a history of depression are significantly more likely to have TGA and TGA recurrence.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Likewise, mental shock and high-stress events are precipitating factors of TGA.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Interestingly, in one study in a patient with post-traumatic stress disorder, the exposure to a stressful trigger resulted in decreased regional cerebral blood flow in areas involved in memory, emotion, attention and motor-control. The administration of fluoxetine resulted in normalization of cerebral blood flow in these areas.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The selective serotonin reuptake inhibitor discontinuation syndrome can occur with any selective serotonin reuptake inhibitor, although antidepressants with short half-lives are associated with a higher risk of discontinuation syndrome, compared to antidepressants with a long half-life. Usually, the symptoms occur within two to four days after drug cessation and the most common symptoms are Flu-like symptoms, dizziness, “shocklike sensations,” gait incoordination, nausea, insomnia and hyperarousal.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Amnesia as an isolated manifestation of a selective serotonin reuptake inhibitor discontinuation syndrome is rare and, as this case shows, a clinical picture compatible with transient global amnesia can be seen after abrupt discontinuation of escitalopram. The causality algorithm of the Spanish Pharmacovigilance System showed a score of 6, indicating a probable relationship between the patient's transitory global amnesia and his abrupt discontinuation of escitalopram. To my knowledge, similar cases have not been reported and a PubMed search without a year filter with the MeSH terms “Transient Global Amnesia” and “escitalopram” showed no results.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Some authors point out that extensive evaluation of patients with transient global amnesia is not necessary unless there are atypical features.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Therefore, it is important to keep in mind that among the less common symptoms of a selective serotonin reuptake inhibitor discontinuation syndrome is amnesia.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Taking this possibility into account can avoid unnecessary complementary explorations.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical considerations</span><p id="par0045" class="elsevierStylePara elsevierViewall">Consent was obtained from the patient for the publication.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0050" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">There is no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Ethical considerations" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Funding" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflict of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transient global amnesia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A.H. 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Sharma" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1503/cmaj.160991" "Revista" => array:5 [ "tituloSerie" => "CMAJ" "fecha" => "2017" "volumen" => "189" "paginaInicial" => "E747" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28554948" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Selective serotonin reuptake inhibitor discontinuation syndrome: a randomized clinical trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.F. Rosenbaum" 1 => "M. Fava" 2 => "S.L. Hoog" 3 => "R.C. Ascroft" 4 => "W.B. 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