Antidepressant induced excessive yawning and indifference

Bruno Palazzo Nazar,Paulo Mattos,João Hiluy

doi:10.1590/0047-2085000000060

Abstract

Introduction Antidepressant induced excessive yawning has been described as a possible side effect of pharmacotherapy. A syndrome of indifference has also been described as another possible side effect. The frequency of those phenomena and their physiopathology are unknown. They are both considered benign and reversible after antidepressant discontinuation but severe cases with complications as temporomandibular lesions, have been described. Methods We report two unprecedented cases in which excessive yawning and indifference occurred simultaneously as side effects of antidepressant therapy, discussing possible physiopathological mechanisms for this co-occurrence. Case 1: A male patient presented excessive yawning (approximately 80/day) and apathy after venlafaxine XR treatment. Symptoms reduced after a switch to escitalopram, with a reduction to 50 yawns/day. Case 2: A female patient presented excessive yawning (approximately 25/day) and inability to react to environmental stressors with desvenlafaxine. Conclusion Induction of indifference and excessive yawning may be modulated by serotonergic and noradrenergic mechanisms. One proposal to unify these side effects would be enhancement of serotonin in midbrain, especially paraventricular and raphe nucleus.

Highlights

Antidepressant induced excessive yawning has been described as a possible side effect of pharmacotherapy
We present here two case reports of antidepressant induced excessive yawning associated with a syndrome of indifference
Two patients experiencing excessive yawning and indifference induced by antidepressants were presented

Summary

INTRODUCTION

Yawning is a common behavior in humans and is considered to have different functions, ranging from modulation of brain thermoregulatory changes to being an emotional manifestation of tiredness or boredom[1]. After one week of escitalopram, he exhibited recurrence of yawning episodes, approximately 3/hour (about 50/day), and after two weeks, started feeling “slow and unresponsive”, and discontinued the medication on his own, presenting resolution of yawning and indifference within days He began bupropion XL 150 mg/day and showed resolution of depressive symptoms without any side effects. A 49-year-old woman, presenting with minor depressive disorder and binge eating disorder (BED), was started on desvenlafaxine, titraded up to 100 mg/day After two weeks, she started experiencing excessive yawning, approximately 2/hour (25 yawns/day). Afterwards, under the suspicion these symptoms could be induced by the antidepressant, she didn’t take it for one week and initiated treatment again, with recurrence of symptoms along another month She had her medication discontinued with complete resolution of side effects after few days and was started on topiramate 50 mg/day with binge remission. J Bras Psiquiatr. 2015;64(1):[82-5]

DISCUSSION

CONFLICTS OF INTEREST