Robin Hieber

Combination of venlafaxine and phentermine/topiramate induced psychosis: A case report

Background: 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. Case Report: 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. Discussion: 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.

Acute psychosis secondary to suspected hyperparathyroidism: A case report and literature review

Introduction: Hyperparathyroidism begins as a benign disease that is often left undetected unless the patient presents with severe symptoms. Often, the first sign of hyperparathyroidism is elevation in serum calcium. Case Description: A 38-year-old man presented with new onset acute psychosis. Laboratory testing revealed co-occurring untreated hyperparathyroidism. Discussion: A literature search was performed using PubMed to identify articles published in English with the following key terms: “hyperparathyroidism,” “psychosis,” and “hypercalcemia.” A review of findings follows the case report. Despite a thorough literature review, any pathophysiological explanation for psychiatric manifestations of hyperparathyroidism remains hypothetical.

Mania possibly linked with bupropion for smoking cessation: A case report

Bupropion is an antidepressant thought to have a reduced risk of inducing mood switching as compared to other antidepressants. Minimal information is available on the induction of mood shifts when used for smoking cessation. This case describes a 38-year-old female who experienced mania following initiation of bupropion for smoking cessation. After completion of a thorough literature search, this appears to be the first case report describing mania induced by bupropion that was refractory to medications and was resolved with electroconvulsive therapy. This case highlights the need for clinicians to perform thorough histories of patients to avoid missing psychiatric history prior to starting bupropion as well as monitor for changes in mood or behavior after initiation of therapy.