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Serotonin reuptake inhibitors,
paranoia, and the ventral basal ganglia.
Lauterbach
EC.
Department of Psychiatry and Behavioral Sciences, Mercer
University School of Medicine, Macon, Georgia
31207.
Antidepressants have previously been associated with
paranoid reactions in psychiatric patients. Five cases of paranoid
exacerbation with the serotonin reuptake inhibitors fluoxetine and
amitriptyline are reported here. Elements common to these cases included
a history of paranoid symptomatology and the concomitant occurrence of
depressive and psychotic symptoms. Complicated depressive disorders
(including atypicality of course and symptomatology, chronicity,
psychosis, bipolarity, and secondary onset in the course of a primary
psychosis) may present particular vulnerability to paranoid
exacerbations associated with serotonin reuptake inhibitors. Although
the pharmacology and neurobiology of paranoia remain cryptic, several
mechanisms, including 5HT3 receptor-mediated dopamine release,
beta-noradrenergic receptor downregulation, or GABAB receptor
upregulation acting in the vicinity of the ventral basal ganglia
(possibly in lateral orbitofrontal or anterior cingulate circuits),
might apply to this phenomenon. These cases call attention to possible
paranoid exacerbations with serotonin reuptake blockers in select
patients and raise neurobiological considerations regarding
paranoia.
Publication Types:
PMID: 1837756 [PubMed - indexed for
MEDLINE]
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