Abstract
To the Editor
Depression is a common comorbidity of Parkinson’s disease, occurring in some form in 35% of patients (Reijnders et al., 2008). For many clinicians selective serotonin reuptake inhibitors are the preferred choice of medication for depression in Parkinson’s disease. Wermuth et al. (1998) have previously reported side effects of citalopram in patients with Parkinson’s disease, including increased sweating, nausea and vomiting, sexual dysfunction and diarrhoea. Although there have been reports of confusion and visual hallucinations occurring with the use of fluvoxamine and amitriptyline (Rabey et al., 1996), there have not been any reports of auditory hallucinations associated with antidepressant medication in Parkinson’s disease.
An 80-year-old man living with his wife was referred to me for assessment following a suicide attempt. He had a background history of Parkinson’s disease diagnosed a year earlier, for which he was treated with levodopa/carbidopa (100 mg/25 mg) three times a day. His other medical problems included metastatic prostate cancer (bone secondaries), chronic cellulitis and gastro-oesophageal reflux. There was no past psychiatric history. There was no reported cognitive impairment and his Mini Mental State Examination score was 29/30.
He had a non-melancholic, non-psychotic major depression and was commenced on citalopram. After taking 10 mg for a couple of days he reported nausea, insomnia and auditory hallucinations of his name being called. He would check to see if anyone was at the door and became scared when he realised that no one was there. He was assessed by his general practitioner, who did not find any evidence of organic pathology. There were no hallucinations in other modalities or delusions. There was no thought disorder or change in cognition or level of function suggestive of delirium. He persisted with the citalopram at an increased dose of 20 mg mane for a couple of days and then ceased due to continued adverse effects. The auditory hallucinations stopped within 2 days.
Isolated auditory hallucinations may occur in approximately 2% of patients with Parkinson’s disease (Fenelon et al., 2000). However, in this case the onset of auditory hallucinations corresponded to the commencement of citalopram and resolved rapidly upon cessation of the medication. Additionally, the patient experienced the hallucinations in the absence of any other psychotic symptoms or cognitive deficits.
In a recent meta-analysis, Skapinakis et al. (2010) concluded that there is a lack of evidence to guide the treatment of depression in Parkinson’s disease. They noted that there are only a small number of studies available and that patients included in these studies may not be representative of those seen in clinical practice. For example, those people with suicidal ideation and comorbid medical disorders (such as in this case) are often excluded. This report describes citalopram-induced auditory hallucinations in a cognitively intact older man with depression and Parkinson’s disease.