Acute parotitis associated with depression and psychoactive drug therapy

Abstract

Acute suppurative parotitis was first distinguished from mumps in 1834 by Brodie. 1 Before the discovery of antibiotics it commonly occurred postoperatively or in debilitated states and had a high mortality rate. 2 Following the introduction of antibiotics there was a striking reduction in both incidence and mortality rate. 3 Acute parotitis had become so rare by the 1950's that Robinson called it a “vanishing disease” 4 but during the late 1950's it reemerged. 5,6 The 1960's have seen a continued rise in the incidence of acute parotitis, whereas the mortality rate, although still alarming at 23% to 35%, has not increased since the mid-1940's. 3,7 The increased incidence of acute parotitis appears to be related to the increase in the proportion of the population that is elderly, especially those in nursing homes because of chronic illness and the emergence of antibiotic-resistant bacteria. 3,7,8 The disease has been associated with malnutrition, oral infection, and poor oral and systemic hydration. 3,7,9 Xerostomia, with diminished salivary secretion, and poor oral hygiene predispose to the infection. 10 The offending organism is usually Staphylococcus aureus. 3,7,11 Acute pyogenic parotitis is characterized by sudden onset, local pain and swelling, and is sometimes accompanied by fever and chills. Other causes of acute parotitis include mumps, blockage of Stensen's duct by a calculus, diabetes mellitus, alcoholic cirrhosis, and drug hypersensitivity reactions. 3,7,10,12 Bilateral parotid enlargement has been reported in a patient taking thioridazine. 13 Ragheb reported acute pyogenic parotitis in three geriatric patients, all of whom had dryness of the mouth as a side effect of prolonged use of one or more of the following psychoactive medications: triflupromazine, chlorpromazine, amitriptyline, and benztropine mesylate. 14 This article was stimulated by (1) finding only one report 14 in the literature associating psychoactive drugs and parotitis, (2) finding no previous reports of the etiologic significance of severe depression and its vegetative components, and (3) the significance of this complication in view of the fact that depression is common and the use of antipsychotics and antidepressants is widespread and increasing.