Bell’s Palsy Development in Patients Using Quetiapine Adjunct to Sertraline: A Case Study

Abstract

Introduction: Bell`s palsy is a neurological condition manifests with acute unilateral neuropathy of 7th cranial nerve. The cause is not clear. However, some infections, immune system responses and ischemic causes are suggested as etiologies. We report 2 cases with Bell`s palsy while using quetiapine plus sertraline, in the absence of concurrent prescriptions which have been reported Bell’s palsy as an adverse effect. Cases Presentation: First patient was an Iranian 54 years old male with Major Depressive Disorder who has been treated by sertraline 100mg per day for 1 year. His main manifestations was depressed mood, fatigue, insomnia, irritability, suicidal ideas and social isolation. He presented the classical manifestations of peripheral Bell`s palsy only 3 days after initiation of quetiapine 50mg per night. Brain imaging such as Magnetic Resonance Imaging (MRI) and Diffusion Weighted Imaging (DWI) was performed. Also other investigations for infective and immune causes were done. All of them showed normal results. The second case was an Iranian 20 year old female diagnosed as Major Depressive and Body dysmorphic disorder patient. She was being treated by sertraline 100 mg/daily plus quetiapine 25md per night for 15 months. She also presented peripheral type of Bell`s palsy while using this combination therapy. Neurological investigations also performed and all results were normal. She recovered after reduction of quetiapine dosage to 12.5 mg per night and prescription of acyclovir and dexamethasone by our neurologist colleague. Discussion: Based on our search there is no reported correlation between psychiatric medications and Bell`s palsy. First explanation about our cases is an accidental correlation but also the short time correlation between initiation of treatment and presenting Bell’s palsy in first case and recovery of second one after reduction of quetiapine dosage are supporting the idea that the combination of sertraline and quetiapine may causes Bell’s palsy. Some articles have mentioned that antipsychotic drugs may have a weak antibiotic agent role and specially may demonstrate an inhibitory effect on neurotropic viruses, such as herpes simplex. Sertraline may also acts as an antibacterial agent. Reduction of protecting human microbiota may explain our observations. Conclusion: Combination of sertraline and quetiapine may cause Bell`s palsy and clinicians should consider neurological adverse effects of this common combination