To report a case of severe memory loss in an elderly patient after initiation of fluoxetine.
CASE SUMMARY:
An 87-year-old white woman was started on fluoxetine for depression, and the dose was titrated to 20 mg/d. She developed progressive memory loss over the next 6 weeks for which she ultimately was hospitalized. Other potential causes for her memory loss were ruled out. After fluoxetine was discontinued, the patient's memory improved significantly over the next 2 months. An objective causality assessment indicated a possible relationship between the memory loss and fluoxetine in this patient.
DISCUSSION:
Our report documents a case of severe reversible memory deterioration after initiating fluoxetine. Fluoxetine has a favorable adverse effect profile when compared with older classes of antidepressants. Postmarketing studies and isolated case reports, however, suggest that fluoxetine may harm memory in some patients. Some selective serotonin-reuptake inhibitors (SSRIs) appear to cause memory loss more frequently than others.
CONCLUSIONS:
Clinicians should be aware of the possible effects of fluoxetine (and possibly other SSRIs) on memory.
SacktorNCMayeuxR.Symptoms of neurologic disorders. In: BussyRK, ed. Merritt's textbook of neurology. Baltimore: Williams & Wilkins, 1995:1–8.
7.
VictorMRopperAH.Dementia and the amnesic (Korsakoff) syndrome. In: Principles of neurology. New York: McGraw-Hill, 2001:444–63.
8.
MirowS.Cognitive dysfunction associated with fluoxetine (letter). Am J Psychiatry1991;148:948–9.
9.
BradleySJKulikL.Fluoxetine and memory impairment. J Am Acad Adolesc Psychiatry1993;32:1078–9.
10.
BangsMEPettiTAJanusMD.Fluoxetine-induced memory impairment in an adolescent. J Am Acad Child Adolesc Psychiatry1994;33:1303–6.
11.
SinghRGuptaASinghB.Acute organic brain syndrome after fluoxetine treatment (letter). Am J Psychiatry1995;152:295–6.
12.
HallTBarreraRDRandonM.Reversible memory loss following treatment with fluoxetine: A case study. Behav Intervent2000;15:217–24.
13.
LeggJFStiffM P.Drug-related test patterns of depressed patients. Psychopharmacology (Berl)1976;50(2):205–10.
14.
SchatzbergAFColeJOBlumerDP.Speech blockade: A tricyclic side effect. Am J Psychiatry1978;135:600–1.
15.
PandeACSaylerME.Adverse events and treatment discontinuations in fluoxetine clinical trial. Int Clin Psychopharmacol1993;8:267–9.
16.
MoskowitzHBurnsM.The effect on performance of two antidepressants, alone and in combination with diazepam. Prog Neuropsychopharmacol Biol Psychiatry1988;12:783–92.
17.
FudgeJLPerryPJGarveyMJKellyMW.A comparison of the effects of fluoxetine and trazodone on the cognitive functioning of depressed outpatients. J Affect Disord1990;18:275–80.
18.
TaraganoFELyketsosCGMangoneCAAllegriRFComesana-DiazE.A double-blind, randomized, fixed-dose trial of fluoxetine vs. amitriptyline in the treatment of major depression complicating Alzheimer's disease. Psychosomatics1997;38:246–52.
19.
CassanoGBPucaFScapicchioPLTrabucchiM, for the Italian Study Group on Depression in Elderly Patients. Paroxetine and fluoxetine effects on mood and cognitive functions in depressed nondemented elderly patients. J Clin Psychiatry2002;63:396–402.
20.
NebesRDPollockBGMulsantBHButtersMAZmudaMDReynoldsCF3rd.Cognitive effects of paroxetine in older depressed patients. J Clin Psychiatry1999;60(suppl 20):26–9.
21.
SchmittJAKruizingaMJRiedelWJ.Non-serotonergic pharmacological profiles and associated cognitive effects of serotonin reuptake inhibitors. J Psychopharmacol2001;15:173–9.
22.
FurlanPMKallanMJTen HaveTPollockBGKatzILuckiI.Cognitive and psychomotor effects of paroxetine and sertraline on healthy elderly volunteers. Am J Geriatr Psychiatry2001;9:429–38.
23.
HarmerCJBhagwagarZCowenPJGoodwinGM.Acute administration of citalopram facilitates memory consolidation in healthy volunteers. Psychopharmacology2002;163:106–10.
24.
FairweatherDBAshfordJHindmarchI.Effects of fluvoxamine and dothiepin on psychomotor abilities in healthy volunteers. Pharmacol Biochem Behav1996;53:265–9.
25.
LinnoilaMStapletinJMGeorgeDTLaneEEckardtMJ.Effects of fluvoxamine, alone and in combination with ethanol, on psychomotor and cognitive performance and on autonomic nervous system reactivity in healthy volunteers. J Clin Psychopharmacol1993;13:175–80.
Package insert. Paxil CR (paroxetine). Research Triangle Park, NC: GlaxoSmithKline, April 2002.
28.
Package insert. Zoloft (sertraline). New York: Pfizer, October 2002.
29.
Package insert. Celexa (citalopram). St. Louis: Forest Laboratories, August 2002.
30.
GoodnickPJGoldsteinBJ.Selective serotonin reuptake inhibitors in affective disorders - I. Basic pharmacology. J Psychopharmacol1998;12(3 suppl B):S5–20.
31.
RichardsonJSKeeganDLBowenRCBlackshawSLCebrian-PerezSDayalSVerbal learning by major depressive disorder patients using treatment with fluoxetine and amitriptyline. Int Clin Psychopharmacol1994;9:35–40.
32.
LucianaMCollinsPFDepueRA.Opposing roles for dopamine and serotonin in the modulation of human spatial working memory functions. Cerebral Cortex1998;8:218–26.
33.
NaranjoCABustoUSellersEMSandorPRuizIRobertsEAA method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther1981;30:239–45.
