Sibutramine-Associated Psychotic Episode

Ms. A, a 19-year-old woman, was admitted to a psychiatric hospital because of acute paranoid symptoms. She had no history of psychiatric treatment, neurologic disturbances, or substance abuse. She had been given sibutramine (10 mg/day) to treat obesity. At first the drug was not well tolerated; side effects of sleeplessness, mild anxiety, and tachycardia emerged. After 8 weeks of therapy and a dose increase (to 15 mg/day), Ms. A began to be anxious and complained of sleep disturbances, lack of appetite, constipation, and severe abdominal pain. Sibutramine therapy was withdrawn, and the side effects slowly faded, but in the next 7 days her mental state progressively deteriorated.

At admission to the psychiatric ward, Ms. A was preoccupied with internal stimuli and withdrawn and experiencing delusions of reference and auditory hallucinations. Clear signs of severe formal thought disorder were also present. Her heart rate was 100 bpm, and her blood pressure was elevated, at 130/100 mm Hg. The results of laboratory tests, a computerized tomography scan of her brain, ECG, and EEG did not reveal any significant abnormalities. She was given perazine, 500 mg/day, and within 20 days her mental state had improved, and her vital signs were normal. The 4-week follow-up revealed no psychotic symptoms, although Ms. A’s antipsychotic treatment continued.