Psychiatry and Clinical Psychopharmacology

Panax ginseng, sildenafil, and rasagiline induced psychiatric symptoms in patients with Parkinson’s disease: two case reports

Psychiatry and Clinical Psychopharmacology 2014; 24: Supplement S358-S359
Read: 1603 Published: 17 February 2021

Depression, anxiety disorder, or mania, are frequently related to dopamine replacement therapy in Parkinson’s disease. Moreover, psychosis, Obsessive compulsive disorder, hypersexuality, levodopa addiction and pathologic gambling are considered as secondary to the use of dopamimetic drugs. In this case report, we report two patients with PD, the first who developed psychotic mania following administration of a combination of Panax ginseng and sildenafil, the second who manifested some compulsive behaviors during the treatment of rasagiline. Case 1: A 70-year-old married man with a diagnosis of PD was admitted for counting compulsions and ritualistic behaviors. He was administrated ropinirole 12 mg/day, and rasagiline 1 mg/day with a diagnosis of PD one and half year ago. Despite partial remission in his symptoms and functionality, the patient did not use rasagiline because of an erectile dysfunction for one year. Two months ago, rasagiline 1mg/day was added again to ongoing 12 mg/day dose of ropinirole since his symptoms of PD worsened. A few days later, he began repeatedly to count the number set of 3,13,23 before performing specific actions throughout the day. At admission, The Hoehn and Yahr Scale revealed a stage 1.5 score for PD. He scored 18 on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). In addition to rasagiline treatment, sertraline was started at 25 mg/d and titrated up to 75 mg/day for his compulsive symptoms. At the end of fourth week, his Y-BOCS score was decreased to 13. Case 2: Mr. D was a 57-year-old, married male was admitted for paranoid thoughts and aggressive behaviors. He has been under treatment of pramipexole 1,5 mg/day, rasagiline mesylate 1 mg/day, and amantadine sulfate 200 mg/day for one year without any psychiatric symptoms. He was started sildenafil for his erectile dysfunction. A few days later, several manic and psychotic symptoms such as, euphoria, insomnia, anger attacks, jealousy and persecution delusions were observed. After sildenafil was stopped, he own began to use Panax ginseng which also contains sildenafil for his symptoms of PD. Within one month, his manic and paranoid symptoms worsened. At admission, he scored 35 on the Young Mania Rating Scale (YMRS). His total Scale for Assessment of Positive Symptoms (SAPS) score was 9. The Hoehn and Yahr Scale revealed a stage 2 score for the PD. In addition to levodopa, carbidopa, and entacapone treatment, we administrated aripiprazole 5 mg/day, quetiapine 75 mg/day and valproic acid 750 mg/day to manage his manic and psychotic symptoms. Four weeks later, his total scores of YMRS and SAPS were decreased to 8 and 2, respectively. His Hoehn and Yahr Scale scores remained unchanged.

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