SYMPOSIA
SYMPOSIA
SYMPOSIA
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
Poster Presentations<br />
eating disorders, alcohol or drug abuse are most often found in individuals with bulimia nervosa and bulimic behaviors. Also, binge eating/<br />
purging anorexics appear to be more likely than restricting anorexics to indulge in substance use. Patients with bulimia nervosa have<br />
significantly higher rates of use of amphetamines, barbiturates, marijuana, tranquilizers, and cocaine than patients with anorexia nervosa.<br />
Compounds of cannabis like tetrahydrocannabinol activate endogenous cannabinoid receptors (CB1 and CB2) in brain. Stimulating the CB1<br />
receptor is known to cause increased appetite and an antiemetic effect and because of these effects cannabinoids are included in clinical<br />
use. In this case report, an anorexia nervosa case, who was a young female patient using cannabis, will be presented. The patient, a 17 yearold,<br />
high school student, lived with her family, had complaints of weight loss and had used cannabis for three years. Before beginning to<br />
use cannabis her BMI was approximately 22, when referred to our clinic it was 15.6. She indicated that at first cannabis caused increased<br />
appetite, but excessive vomiting occurred in the first few months and then she started to exercise excessively. Although she noticed losing<br />
weight in this way, she did not stop the use of cannabis. According to a review of the literature in Turkey, such a case of cannabis use and<br />
anorexia nervosa comorbidity hasn’t previously been reported. In this respect, discussion of the case in detail is important.<br />
Key words: Anorexia nervosa, cannabis, substance abuse, eating disorders<br />
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S129-30<br />
[PP-016] Ref. No: 249<br />
Fluoxetine-induced thrombocytopenia: A case report<br />
Atakan Yucel 1 , Mustafa Gulec 1 , Adem Aydin 2<br />
1Department of Psychiatry, Atatürk University, School of Medicine, Erzurum-Turkey<br />
2Department of Psychiatry, Yuzuncu Yil University, School of Medicine, Van-Turkey<br />
E-mail: mustafagulec78@yahoo.com<br />
Case: A 44 year old, university graduate, married male with 2 children was diagnosed with a first episode major depressive disorder<br />
and no abnormalities were observed in the routine tests, including the total blood count test carried out prior to commencing drug<br />
therapy. Afterwards the patient was prescribed fluoxetine and the daily total drug dose was set at 10 mg for the first week of treatment<br />
and 20 mg for the following 3 weeks. During the first follow up visit after thirty days, it was observed that the patient had gone into a<br />
total remission and no change was made in the pharmacotherapy. However, it was learned that thrombocytopenia was detected in the<br />
total blood count test requested by the family doctor because of a suspicion of a urinary tract infection. Since no pathology that could<br />
account for the thrombocytopenia that was detected by a hematology expert following standard consultation and further tests, the<br />
patient was transferred back to us with a suspicion of fluoxetine induced thrombocytopenia. Fluoxetine was immediately discontinued<br />
and replaced with reboxetine and similarly reboxetine was prescribed as 4 mg/day for the first week and as 8 mg/day after the first week.<br />
The thrombocytopenia of the patient went into total remission within 7 days and no problem was observed during the total blood count<br />
tests for the next 6 months.<br />
Even though the most common side effects of fluoxetine are nausea, nervousness, and insomnia, side effects of the hematological<br />
system have also been noted. To this end, there are publications which suggest possible negative effects on the number and function of<br />
thrombocytes. It is thought that the mechanism behind these hemostasis related side effects of fluoxetine is the depletion of serotonin<br />
stores by preventing the reuptake of serotonin into thrombocytes. Starting from this hypothesis, the presumption is that reboxetine,<br />
which is a pure noradrenaline reuptake inhibitor, will have no effect on these processes. In fact, there have been no reports that relate<br />
reboxetine with thrombocytopenia and/or thrombocyte functional disorders. However it should be clarified with further studies whether<br />
this is purely coincidental or if reboxetine has no effect on serotonergic systems.<br />
Conclusion: Reboxetine may be a good alternative for patients with thrombocytopenia and/or with functional thrombocyte disorders in<br />
the treatment of major depressive disorders. However, more research is required in order to reach more certain conclusions.<br />
Key words: Depression, hematological, side effect, switching, reboxetine, fluoxetine, thrombocytopenia<br />
References:<br />
1. Pai VB, Kelly MW. Bruising associated with the use of fluoxetine. Ann Pharmacother 1996; 30(7-8):786-788<br />
2. Mirsal H, Kalyoncu A, Pektaş O. Ecchymosis associated with the use of fluoxetine: case report. Turk Psikiyatri Derg 2002; 13(4):320-324<br />
3. Halperin D, Reber G. Influence of antidepressants on hemostasis. Dialogues Clin Neurosci 2007; 9(1):47-59<br />
4. Lewis G, Mulligan J, Wiles N, Cowen P, Craddock N, Ikeda M, et al. Polymorphism of the 5-HT transporter and response to antidepressants: randomised controlled<br />
trial. Br J Psychiatry 2011; 198(6):464-471<br />
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S130<br />
S130 Bulletin of Clinical Psychopharmacology, Vol: 21, Supplement: 2, 2011 - www.psikofarmakoloji.org