Hematochezia Caused by Tandospirone in a Patient with Major Depressive Disorder and Anxious Distress: a Case Report

Overview

Journal Front Psychiatry

Specialty Psychiatry

Date 2023 Aug 2

PMID 37529069

Authors

Xingmei Jiang

Zhongrui Ma

Zhixiong Li

Ying Ou

Zhenhua Luo

Zhe Li

Affiliations

Soon will be listed here.

Abstract

Background: Major depressive disorder (MDD) with anxious distress is a relatively common condition that is often associated with a poor treatment response. In order to enhance the effectiveness of MDD treatment, 5-HT1A agonists like tandospirone are often prescribed in conjunction with antidepressants. While it is known that antidepressants can increase the risk of bleeding, whether tandospirone poses a similar risk remains uncertain.

Case Presentation: We presented the case of a 55-year-old Chinese woman diagnosed with MDD and anxious distress. After receiving various types of antidepressants, she experienced hematochezia following the administration of tandospirone, sertraline, and agomelatine. The occurrence of hematochezia ceased after tandospirone was discontinued. The patient was subsequently discharged with a treatment regime consisting of sertraline and agomelatine. During the 1-month follow-up, she reported no hematochezia.

Conclusion: Tandospirone may potentially increase the risk of hematochezia in patients with MDD and anxious distress.

References

Huang Y, Wang Y, Wang H, Liu Z, Yu X, Yan J . Prevalence of mental disorders in China: a cross-sectional epidemiological study. Lancet Psychiatry. 2019; 6(3):211-224. DOI: 10.1016/S2215-0366(18)30511-X. View

Baghai T, Blier P, Baldwin D, Bauer M, Goodwin G, Fountoulakis K . General and comparative efficacy and effectiveness of antidepressants in the acute treatment of depressive disorders: a report by the WPA section of pharmacopsychiatry. Eur Arch Psychiatry Clin Neurosci. 2011; 261 Suppl 3:207-45. DOI: 10.1007/s00406-011-0259-6. View

Nishitsuji K, To H, Murakami Y, Kodama K, Kobayashi D, Yamada T . Tandospirone in the treatment of generalised anxiety disorder and mixed anxiety-depression : results of a comparatively high dosage trial. Clin Drug Investig. 2007; 24(2):121-6. DOI: 10.2165/00044011-200424020-00007. View

Dimitriou E, Dimitriou C . Buspirone augmentation of antidepressant therapy. J Clin Psychopharmacol. 1998; 18(6):465-9. DOI: 10.1097/00004714-199812000-00009. View

Turner M, May D, Arthur R, Xiong G . Clinical impact of selective serotonin reuptake inhibitors therapy with bleeding risks. J Intern Med. 2007; 261(3):205-13. DOI: 10.1111/j.1365-2796.2006.01720.x. View

Lanas A, Carrera-Lasfuentes P, Arguedas Y, Garcia S, Bujanda L, Calvet X . Risk of upper and lower gastrointestinal bleeding in patients taking nonsteroidal anti-inflammatory drugs, antiplatelet agents, or anticoagulants. Clin Gastroenterol Hepatol. 2014; 13(5):906-12.e2. DOI: 10.1016/j.cgh.2014.11.007. View

de Abajo F . Effects of selective serotonin reuptake inhibitors on platelet function: mechanisms, clinical outcomes and implications for use in elderly patients. Drugs Aging. 2011; 28(5):345-67. DOI: 10.2165/11589340-000000000-00000. View

Niwa T, Shiraga T, Ishii I, Kagayama A, Takagi A . Contribution of human hepatic cytochrome p450 isoforms to the metabolism of psychotropic drugs. Biol Pharm Bull. 2005; 28(9):1711-6. DOI: 10.1248/bpb.28.1711. View

Choi K, Kim Y, Jeon H . Comorbid Anxiety and Depression: Clinical and Conceptual Consideration and Transdiagnostic Treatment. Adv Exp Med Biol. 2020; 1191:219-235. DOI: 10.1007/978-981-32-9705-0_14. View

10.

Carvalho A, Sharma M, Brunoni A, Vieta E, Fava G . The Safety, Tolerability and Risks Associated with the Use of Newer Generation Antidepressant Drugs: A Critical Review of the Literature. Psychother Psychosom. 2016; 85(5):270-88. DOI: 10.1159/000447034. View

11.

Ruscio A, Hallion L, Lim C, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J . Cross-sectional Comparison of the Epidemiology of DSM-5 Generalized Anxiety Disorder Across the Globe. JAMA Psychiatry. 2017; 74(5):465-475. PMC: 5594751. DOI: 10.1001/jamapsychiatry.2017.0056. View

12.

Sasa M . [A new approach to innovating selective anxiolytics: pharmacological profile of a novel 5-HT1A agonist (tandospirone)]. Nihon Shinkei Seishin Yakurigaku Zasshi. 1997; 17(2):53-9. View

13.

Wang Y, Chen Y, Tsai C, Li S, Luo J, Wang S . Short-term use of serotonin reuptake inhibitors and risk of upper gastrointestinal bleeding. Am J Psychiatry. 2013; 171(1):54-61. DOI: 10.1176/appi.ajp.2013.12111467. View

14.

Hussain F, Dobson E, Strawn J . Pharmacologic Treatment of Pediatric Anxiety Disorders. Curr Treat Options Psychiatry. 2016; 3(2):151-160. PMC: 5026391. DOI: 10.1007/s40501-016-0076-7. View

15.

Andrade C, Sandarsh S, Chethan K, Nagesh K . Serotonin reuptake inhibitor antidepressants and abnormal bleeding: a review for clinicians and a reconsideration of mechanisms. J Clin Psychiatry. 2010; 71(12):1565-75. DOI: 10.4088/JCP.09r05786blu. View

16.

Naranjo C, Busto U, Sellers E, Sandor P, Ruiz I, Roberts E . A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981; 30(2):239-45. DOI: 10.1038/clpt.1981.154. View

17.

Naveed M, Li L, Sheng G, Du Z, Zhou Y, Nan S . Agomelatine: An Astounding Sui-generis Antidepressant?. Curr Mol Pharmacol. 2021; 15(7):943-961. DOI: 10.2174/1874467214666211209142546. View

18.

Parker D, Byng R, Dickens C, McCabe R . Patients' experiences of seeking help for emotional concerns in primary care: doctor as drug, detective and collaborator. BMC Fam Pract. 2020; 21(1):35. PMC: 7020382. DOI: 10.1186/s12875-020-01106-z. View

19.

Tyrer P, Baldwin D . Generalised anxiety disorder. Lancet. 2006; 368(9553):2156-66. DOI: 10.1016/S0140-6736(06)69865-6. View

20.

Hung C . Factors predicting adherence to antidepressant treatment. Curr Opin Psychiatry. 2014; 27(5):344-9. DOI: 10.1097/YCO.0000000000000086. View