Yeungnam Univ J Med.  2019 Sep;36(3):249-253. 10.12701/yujm.2019.00150.

Apathy syndrome in a patient previously treated with selective serotonin reuptake inhibitors for depression

• Kim HG
• Koo BH
• Lee SW
• Cheon EJ

• KMID: 2460194
• DOI: http://doi.org/10.12701/yujm.2019.00150

Abstract

There is considerable overlap in the clinical presentations of apathy and depression. However, differential diagnosis between apathy and other psychiatric conditions, including depression and dementia, is important. In this report, we present the case of a 67-year-old woman with a history of receiving selective serotonin reuptake inhibitor (SSRI) treatment for depression. Differential diagnosis between treatment-resistant depression and SSRI-induced apathy syndrome was required. The symptoms of her apathy syndrome were relieved after the discontinuation of SSRIs and the addition of olanzapine, methylphenidate, and modafinil. Furthermore, we briefly review related literature in this article.

Keyword

Apathy; Depression; Serotonin reuptake inhibitor

MeSH Terms

Aged
Apathy*
Dementia
Depression*
Diagnosis, Differential
Female
Humans
Methylphenidate
Serotonin
Serotonin Uptake Inhibitors*
Methylphenidate
Serotonin
Serotonin Uptake Inhibitors

Figure

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  Fig. 1. No degenerative changes on T2-flair image. RPF, right posterior feet.

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  Fig. 2. Mild reduction of perfusion in anterior cingulate gyrus on brain single-photon emission computed tomography.

Reference

References

1. Marin RS. Apathy: a neuropsychiatric syndrome. J Neuropsychiatry Clin Neurosci. 1991; 3:243–54.

2. Barnhart WJ, Makela EH, Latocha MJ. SSRI-induced apathy syndrome: a clinical review. J Psychiatr Pract. 2004; 10:196–9.

3. Starkstein SE, Jorge R, Mizrahi R, Robinson RG. A prospective longitudinal study of apathy in Alzheimer's disease. J Neurol Neurosurg Psychiatry. 2006; 77:8–11.

4. Padala PR, Burke WJ, Bhatia SC. Modafinil therapy for apathy in an elderly patient. Ann Pharmacother. 2007; 41:346–9.

5. Roth RM, Flashman LA, McAllister TW. Apathy and its treatment. Curr Treat Options Neurol. 2007; 9:363–70.

6. McPherson S, Fairbanks L, Tiken S, Cummings JL, Back-Madruga C. Apathy and executive function in Alzheimer's disease. J Int Neuropsychol Soc. 2002; 8:373–81.

7. Wongpakaran N, van Reekum R, Wongpakaran T, Clarke D. Selective serotonin reuptake inhibitor use associates with apathy among depressed elderly: a case-control study. Ann Gen Psychiatry. 2007; 6:7.

8. Dubini A, Bosc M, Polin V. Do noradrenaline and serotonin differentially affect social motivation and behaviour? Eur Neuropsychopharmacol. 1997; 7(Suppl 1):S49–55.

9. Lanctôt KL, Agüera-Ortiz L, Brodaty H, Francis PT, Geda YE, Ismail Z, et al. Apathy associated with neurocognitive disorders: Recent progress and future directions. Alzheimers Dement. 2017; 13:84–100.

10. Galynker I, Ieronimo C, Miner C, Rosenblum J, Vilkas N, Rosenthal R. Methylphenidate treatment of negative symptoms in patients with dementia. J Neuropsychiatry Clin Neurosci. 1997; 9:231–9.

11. van Reekum R, Bayley M, Garner S, Burke IM, Fawcett S, Hart A, et al. N of 1 study: amantadine for the amotivational syndrome in a patient with traumatic brain injury. Brain Inj. 1995; 9:49–53.

12. Marin RS, Fogel BS, Hawkins J, Duffy J, Krupp B. Apathy: a treatable syndrome. J Neuropsychiatry Clin Neurosci. 1995; 7:23–30.

13. Debette S, Kozlowski O, Steinling M, Rousseaux M. Levodopa and bromocriptine in hypoxic brain injury. J Neurol. 2002; 249:1678–82.

14. Newburn G, Newburn D. Selegiline in the management of apathy following traumatic brain injury. Brain Inj. 2005; 19:149–54.

15. Corcoran C, Wong ML, O'Keane V. Bupropion in the management of apathy. J Psychopharmacol. 2004; 18:133–5.

16. Holmes C, Wilkinson D, Dean C, Vethanayagam S, Olivieri S, Langley A, et al. The efficacy of donepezil in the treatment of neuropsychiatric symptoms in Alzheimer disease. Neurology. 2004; 63:214–9.

17. Zhang N, Wei C, Du H, Shi FD, Cheng Y. The effect of memantine on cognitive function and behavioral and psychological symptoms in mild-to-moderate Alzheimer's disease patients. Dement Geriatr Cogn Disord. 2015; 40:85–93.

18. Gerrard P, Malcolm R. Mechanisms of modafinil: a review of current research. Neuropsychiatr Dis Treat. 2007; 3:349–64.

19. Camargos EF, Quintas JL. Apathy syndrome treated successfully with modafinil. BMJ Case Rep. 2011; 2011:pii: bcr0820114652.

20. Marangell LB, Johnson CR, Kertz B, Zboyan HA, Martinez JM. Olanzapine in the treatment of apathy in previously depressed participants maintained with selective serotonin reuptake inhibitors: an open-label, flexible-dose study. J Clin Psychiatry. 2002; 63:391–5.