SYMPOSIA

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