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Augmentation of phenelzine with aripiprazole and quetiapine in a treatment-resistant patient with psychotic unipolar depression: case report and literature review

Published online by Cambridge University Press:  22 December 2016

Jonathan M. Meyer ,
Michael A. Cummings  and
George Proctor
Jonathan M. Meyer*
Affiliation:
California Department of State Hospitals, Psychopharmacology Resource Network, Department of State Hospitals–Patton, Patton, California 92369, USA
Michael A. Cummings
Affiliation:
California Department of State Hospitals, Psychopharmacology Resource Network, Department of State Hospitals–Patton, Patton, California 92369, USA
George Proctor
Affiliation:
California Department of State Hospitals, Psychopharmacology Resource Network, Department of State Hospitals–Patton, Patton, California 92369, USA
*
*Address for correspondence: Jonathan M. Meyer, MD, California Department of State Hospitals, Psychopharmacology Resource Network, Department of State Hospitals–Patton, 3102 East Highland Avenue, Patton, CA 92369, USA. (Email: jonathan.meyer@dsh.ca.gov)
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Abstract

Irreversible monoamine oxidase inhibitor (MAOI) antidepressants have significant efficacy in treatment-resistant unipolar depression, but in some instances patients may not achieve remission. Among the adjunctive and augmentation strategies, certain second-generation antipsychotics (SGAs) have approval for inadequate responders to antidepressant therapy, including aripiprazole, brexpiprazole, and quetiapine, with lurasidone and the olanzapine/fluoxetine combination indicated for bipolar depression. Clinicians may eschew SGA options in part due to the limited literature on SGA–MAOI combinations, with only one published case involving aripiprazole, and none for olanzapine, lurasidone, or brexpiprazole. In addition to the limited publication history on SGA–MAOI treatment, clinicians may also be deterred by uncertainty regarding SGA mechanisms and the risk of serotonin syndrome or other adverse outcomes. This paper describes the case of a 54-year-old male with a history of psychotic unipolar depression treated with a combination of phenelzine, aripiprazole, and quetiapine, and reviews the 12 published cases of SGA–MAOI combination therapy with a focus on the pharmacological basis for serotonin syndrome, and the SGA mechanisms that should not be associated with a risk for this syndrome.

Keywords

Monoamine oxidase inhibitoraripiprazolequetiapinedepressionantipsychotic

Information

Type
Case-Based Review Article
Information
CNS Spectrums , Volume 22 , Issue 5 , October 2017 , pp. 391 - 396
Copyright
© Cambridge University Press 2016 

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References

1. Nierenberg, AA, Fava, M, Trivedi, MH, et al. A comparison of lithium and T3 augmentation following two failed medication treatments for depression: a STAR*D report. Am J Psychiatry. 2006; 163(9): 1519–1530.CrossRefGoogle ScholarPubMed
2. Trivedi, MH, Fava, M, Wisniewski, SR, et al. Medication augmentation after the failure of SSRIs for depression. N Engl J Med. 2006; 354(12): 1243–1252. http://www.nejm.org/doi/pdf/10.1056/NEJMoa052964.CrossRefGoogle ScholarPubMed
3. Shulman, KI, Herrmann, N, Walker, SE. Current place of monoamine oxidase inhibitors in the treatment of depression. CNS Drugs. 2013; 27(10): 789–797.Google Scholar
4. Thase, ME. Antidepressant combinations: cutting edge psychopharmacology or passing fad? Curr Psychiatry Rep. 2013; 15(10): 403.Google Scholar
5. Thomas, SJ, Shin, M, McInnis, MG, Bostwick, JR. Combination therapy with monoamine oxidase inhibitors and other antidepressants or stimulants: strategies for the management of treatment-resistant depression. Pharmacotherapy. 2015; 35(4): 433–449.CrossRefGoogle ScholarPubMed
6. Citrome, L. Adjunctive aripiprazole, olanzapine, or quetiapine for major depressive disorder: an analysis of number needed to treat, number needed to harm, and likelihood to be helped or harmed. Postgrad Med. 2010; 122(4): 39–48.Google Scholar
7. Citrome, L. Brexpiprazole: a new dopamine D2 receptor partial agonist for the treatment of schizophrenia and major depressive disorder. Drugs Today (Barc). 2015; 51(7): 397–414.Google Scholar
8. Sokolski, KN, Brown, BJ. Quetiapine for insomnia associated with refractory depression exacerbated by phenelzine. Ann Pharmacother. 2006; 40(3): 567–570. Epub ahead of print Feb 14.Google Scholar
9. Kohen, I, Gordon, ML, Manu, P. Serotonin syndrome in elderly patients treated for psychotic depression with atypical antipsychotics and antidepressants: two case reports. CNS Spectr. 2007; 12(8): 596–598.CrossRefGoogle ScholarPubMed
10. Koerhuis, MR, Wunderink, A, Nolen, WA. Een psychotische depressie en onvoldoende effect van farmacotherapie en elektroconvulsietherapie: wat zijn de volgende optie [in German] [The treatment of psychotic depression in patients insufficiently responsive to conventional medication and electroconvulsive therapy; what are the options?]. Tijdschr Psychiatr. 2008; 50(2): 107–112. http://www.tijdschriftvoorpsychiatrie.nl/assets/articles/articles_1723pdf.pdf.Google Scholar
11. Frayne, J, Nguyen, T, Kohan, R, De Felice, N, Rampono, J. The comprehensive management of pregnant women with major mood disorders: a case study involving phenelzine, lithium, and quetiapine. Arch Women’s Ment Health. 2014; 17(1): 73–75. Epub ahead of print Nov 8, 2013.Google Scholar
12. Welner, M. Risperidone plus a monoamine oxidase inhibitor for agitated depression crisis. J Clin Psychopharmacol. 1996; 16(6): 460–461.CrossRefGoogle Scholar
13. Stoll, AL, Haura, G. Tranylcypromine plus risperidone for treatment-refractory major depression. J Clin Psychopharmacol. 2000; 20(4): 495–496.Google Scholar
14. Rim, CL, Gitlin, MJ. Ziprasidone, monoamine oxidase inhibitors, and the serotonin syndrome. J Clin Psychopharmacol. 2010; 30(4): 470–471.Google Scholar
15. Goforth, HW, Carroll, BT. Aripiprazole augmentation of tranylcypromine in treatment-resistant major depression. J Clin Psychopharmacol. 2007; 27(2): 216–217.CrossRefGoogle ScholarPubMed
16. Culpepper, L. Reducing the burden of difficult-to-treat major depressive disorder: revisiting monoamine oxidase inhibitor therapy. Prim Care Companion CNS Disord. 2013; 15(5): pii: PCC.13r01515. Epub ahead of print Oct 31. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3907330/.Google ScholarPubMed
17. Brannan, SK, Talley, BJ, Bowden, CL. Sertraline and isocarboxazid cause a serotonin syndrome. J Clin Psychopharmacol. 1994; 14(2): 144–145.CrossRefGoogle Scholar
18. Diamond, S, Pepper, BJ, Diamond, ML, Freitag, FG, Urban, GJ, Erdemoglu, AK. Serotonin syndrome induced by transitioning from phenelzine to venlafaxine: four patient reports. Neurology. 1998; 51(1): 274–276.Google Scholar
19. Graber, MA, Hoehns, TB, Perry, PJ. Sertraline–phenelzine drug interaction: a serotonin syndrome reaction. Ann Pharmacother. 1994; 28(6): 732–735.CrossRefGoogle ScholarPubMed
20. Otte, W, Birkenhager, TK, van den Broek, WW. Fatal interaction between tranylcypromine and imipramine. Eur Psychiatry. 2003; 18(5): 264–265.Google Scholar
21. Gillman, PK. Monoamine oxidase inhibitors: a review concerning dietary tyramine and drug interactions. PsychoTrop Res. 2016; 1: 1–90. http://psychotropical.info/images/Publications-pdfs/MAOI_diet_drug_interactions_2016.pdf. Accessed June 1, 2016.Google Scholar
22. Boyer, EW, Shannon, M. The serotonin syndrome. N Engl J Med. 2005; 352(11): 1112–1120. Erratum in N Engl J Med. 2007; 356(23): 2437, and N Engl J Med. 2009; 361(17): 1714.CrossRefGoogle ScholarPubMed
23. Buckley, NA, Dawson, AH, Isbister, GK. Serotonin syndrome. BMJ. 2014; 348: g1626.CrossRefGoogle ScholarPubMed
24. Evans, RW. The FDA alert on serotonin syndrome with combined use of SSRIs or SNRIs and Triptans: an analysis of the 29 case reports. MedGenMed. 2007; 9(3): 48. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2100123/.Google ScholarPubMed
25. Evans, RW, Tepper, SJ, Shapiro, RE, Sun-Edelstein, C, Tietjen, GE. The FDA alert on serotonin syndrome with use of triptans combined with selective serotonin reuptake inhibitors or selective serotonin–norepinephrine reuptake inhibitors: American Headache Society position paper. Headache. 2010; 50(6): 1089–1099.CrossRefGoogle ScholarPubMed
26. Schuckit, M, Robins, E, Feighner, J. Tricyclic antidepressants and monoamine oxidase inhibitors. Arch Gen Psychiatry. 1971; 24(6): 509–514.CrossRefGoogle ScholarPubMed
27. Young, JP, Lader, MH, Hughes, WC. Controlled trial of trimipramine, monoamine oxidase inhibitors, and combined treatment in depressed outpatients. BMJ. 1979; 2(6201): 1315–1317. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1597363/pdf/brmedj00101-0007.pdf.Google Scholar
28. White, K, Simpson, G. Combined MAOI–tricyclic antidepressant treatment: a reevaluation. J Clin Psychopharmacol. 1981; 1(5): 264–282.Google Scholar
29. Raskin, DE. Combined tricyclic and MAOI treatment of depressed patients. Am J Psychiatry. 1983; 140(10): 1384.Google Scholar
30. Schmauss, M, Kapfhammer, HP, Meyr, P, Hoff, P. Combined MAO inhibitor and tri- (tetra) cyclic antidepressant treatment in therapy-resistant depression. Prog Neuropsychopharmacol Biol Psychiatry. 1988; 12(4): 523–532.Google Scholar
31. McGrath, PJ, Stewart, JW, Nunes, EN, Quitkin, FM. Treatment response of depressed outpatients unresponsive to both a tricyclic and a monoamine oxidase inhibitor antidepressant. J Clin Psychiatry. 1994; 55(8): 336–339.Google Scholar
32. Berlanga, C, Ortega-Soto, HA. A 3-year follow-up of a group of treatment-resistant depressed patients with a MAOI/tricyclic combination. J Affect Disord. 1995; 34(3): 187–192.Google Scholar
33. Zetin, M. Combined use of trazodone and phenelzine in depression: case report. J Clin Psychiatry. 1984; 45(4): 182–183.Google Scholar
34. Nierenberg, AA, Keck, PE Jr. Management of monoamine oxidase inhibitor-associated insomnia with trazodone. J Clin Psychopharmacol. 1989; 9(1): 42–45.Google Scholar
35. Jacobsen, FM. Low-dose trazodone as a hypnotic in patients treated with MAOIs and other psychotropics: a pilot study. J Clin Psychiatry. 1990; 51(7): 298–302.Google Scholar
36. Feinberg, SS. Combining stimulants with monoamine oxidase inhibitors: a review of uses and one possible additional indication. J Clin Psychiatry. 2004; 65(11): 1520–1524.Google Scholar
37. Panisset, M, Chen, JJ, Rhyee, SH, Conner, J, Mathena, J. Serotonin toxicity association with concomitant antidepressants and rasagiline treatment: retrospective study (STACCATO). Pharmacotherapy. 2014; 34(12): 1250–1258. Epub ahead of print Oct 14.Google Scholar
38. Bandres Liso, AC, Toyas Miazza, C. Clinical manifestation of confusion and hallucinations caused by an interaction between rasagiline and escitalopram [in Spanish]. Farm Hosp. 2009; 33(3): 173–175.Google ScholarPubMed
39. Duval, F, Flabeau, O, Razafimahefa, J, Spampinato, U, Tison, F. Encephalopathy associated with rasagiline and sertraline in Parkinson’s disease: possible serotonin syndrome. Mov Disord. 2013; 28(10): 1464. Epub ahead of print Mar 13.CrossRefGoogle ScholarPubMed
40. Suphanklang, J, Santimaleeworagun, W, Supasyndh, O. Combination of escitalopram- and rasagiline-induced serotonin syndrome: a case report and review literature. J Med Assoc Thai. 2015; 98(12): 1254–1257.Google Scholar
41. De Deurwaerdere, P. Cariprazine: new dopamine biased agonist for neuropsychiatric disorders. Drugs of Today (Barc). 2016; 52(2): 97–110.Google Scholar
42. McEvoy, J, Citrome, L. Brexpiprazole for the treatment of schizophrenia: a review of this novel serotonin–dopamine activity modulator. Clin Schizophr Relat Psychoses. 2016; 9(4): 177–186.Google Scholar
43. Dell’Osso, B, Palazzo, MC, Oldani, L, Altamura, AC. The noradrenergic action in antidepressant treatments: pharmacological and clinical aspects. CNS Neurosci Ther. 2011; 17(6): 723–732. Epub ahead of print Dec 14, 2010.Google Scholar
44. Rom, WN, Benner, EJ. Toxicity by interaction of tricyclic antidepressant and monoamine oxidase inhibitor. Calif Med. 1972; 117(6): 65–66. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1518781/pdf/califmed00120-0091.pdf.Google ScholarPubMed
45. Dostert, P, Castelli, MG, Cicioni, P, Strolin Benedetti, M. Reboxetine prevents the tranylcypromine-induced increase in tyramine levels in rat heart. J Neural Transm Suppl. 1994; 411: 49–153.Google Scholar
46. Gillman, PK. Advances pertaining to the pharmacology and interactions of irreversible nonselective monoamine oxidase inhibitors. J Clin Psychopharmacol. 2011; 31(1): 66–74.Google Scholar
47. Daniel, DG, Zimbroff, DL, Potkin, SG, Reeves, KR, Harrigan, EP, Lakshminarayanan, M. Ziprasidone 80 mg/day and 160 mg/day in the acute exacerbation of schizophrenia and schizoaffective disorder: a 6-week placebo-controlled trial. Ziprasidone Study Group. Neuropsychopharmacology. 1999; 20(5): 491–505. http://www.nature.com/npp/journal/v20/n5/full/1395273a.html.Google Scholar
48. Azzaro, AJ, Ziemniak, J, Kemper, E, Campbell, BJ, VanDenBerg, C. Selegiline transdermal system: an examination of the potential for CYP450-dependent pharmacokinetic interactions with 3 psychotropic medications. J Clin Pharmacol. 2007; 47(2): 146–158.Google Scholar
49. Loebel, A, Cucchiaro, J, Silva, R, et al. Lurasidone monotherapy in the treatment of bipolar I depression: a randomized, double-blind, placebo-controlled study. Am J Psychiatry. 2014; 171(2): 160–168.Google Scholar
50. Loebel, A, Cucchiaro, J, Silva, R, et al. Lurasidone as adjunctive therapy with lithium or valproate for the treatment of bipolar I depression: a randomized, double-blind, placebo-controlled study. Am J Psychiatry. 2014; 171(2): 169–177. http://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2013.13070985.Google Scholar
51. Suppes, T, Silva, R, Cucchiaro, J, et al. Lurasidone for the treatment of major depressive disorder with mixed features: a randomized, double-blind, placebo-controlled study. Am J Psychiatry. 2016; 173(4): 400–407. Epub ahead of print Nov 10, 2015.Google Scholar
52. Durgam, S, Earley, W, Guo, H, et al. Efficacy and safety of adjunctive cariprazine in inadequate responders to antidepressants: a randomized, double-blind, placebo-controlled study in adult patients with major depressive disorder. J Clin Psychiatry. 2016; 77(3): 371–378. http://www.psychiatrist.com/jcp/article/Pages/2016/v77n03/v77n0318.aspx.Google Scholar