Vortioxetine as a potential alternative for patients with escitalopram‐induced jitteriness/anxiety syndrome: A report of three cases

• Published in: PCN reports 2023-12, Vol.2 (4), p.e158-n/a
• Main Authors: Arai, Kaoru, Nonaka, Mari, Shimada, Shoko, Nakamura, Masayuki
• Format: Article
• Language: English
• Subjects: Antidepressants; Antipsychotics; Anxiety; Bipolar disorder; Case Report; Case Reports; depression; Emotions; escitalopram; Impulsivity; Insomnia; jitteriness/anxiety syndrome; Lithium; Mental depression; Patients; Pediatrics; Psychotropic drugs; selective serotonin reuptake inhibitor; vortioxetine
• ISSN: 2769-2558; 2769-2558
• DOI: 10.1002/pcn5.158

Background Jitteriness/anxiety syndrome is a recognized adverse effect observed during the initiation or change of dose in antidepressant treatment. Managing patients who develop this syndrome remains a challenge. While escitalopram is a widely used antidepressant known to cause these symptoms, this report explores vortioxetine as a therapeutic alternative. Case Presentation Three distinct clinical scenarios were observed in patients who manifested jitteriness/anxiety syndrome while on escitalopram treatment for depression. Patient A was initiated on escitalopram and experienced an initial alleviation in depressive symptoms, but 3 months later displayed mood elevation, talkativeness, and increased activity, which disturbed his daily life. A transition to vortioxetine subsequently resolved the mood elevation. Patient B exhibited elevated mood, hyperactivity, irritability, and talkativeness just 6 days post‐initiation of treatment with escitalopram. After the discontinuation of escitalopram and unsuccessful trials with aripiprazole, lurasidone, and lamotrigine, her depressive mood intensified, culminating in suicidal ideation. Starting vortioxetine led to a consistent improvement of her symptoms, and she resumed work and was emotionally stable. Patient C was initially diagnosed with bipolar disorder and faced a relapse into depression despite undergoing various treatments. After 2 weeks on escitalopram, she exhibited irritability and self‐harm urges. Three months later, after being re‐diagnosed with depressive disorders with anxious distress, vortioxetine was administered, which significantly reduced her depressive symptoms and allowed her to continue her education. Conclusion Vortioxetine presents as a promising therapeutic alternative that is worth considering for patients with escitalopram‐induced jitteriness/anxiety syndrome. Managing patients who develop antidepressant‐induced jitteriness/anxiety syndrome remains a challenge. Our observations suggest that vortioxetine might offer a safer and more efficacious alternative in such circumstances, especially when the discontinuation of antidepressant therapy is not a suitable option.