Metoprolol
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Sleep disorders, depression and anxiety in an elderly patient: case report An 81-year-old man developed sleep disorders, nightmares, depression and anxiety during treatment with metoprolol for angina pectoris and hypertension. The man started receiving metoprolol 50mg [route not stated] in October 2004; in 2005, his dosage was decreased to 25mg/day. He was admitted in August 2005 for a tonic-clonic seizure. In April 2007, he started treatment with citalopram and oxazepam for depression and anxiety; he also reported vivid dreams and nightmares. In July and August 2008, he was admitted for tonic muscle spasms and seizures, respectively; valproic acid was initiated for the seizures. In November 2008, he was evaluated for an approximately 3-year history of sleep disorders, nightmares, depression and anxiety, with an increase in symptom frequency and severity over the past 6 months. His wife reported nocturnal body movements and unintelligible talking with nightmares involving past war experiences. He felt constantly depressed and anxious, and had discontinued his antidepressant medication which was ineffective. Metoprolol was withdrawn, and replaced with amiodarone; the man’s other medications were continued. His symptoms subsided within 1 week, and he remained free of symptoms at 3-month follow-up. He had a recurrent seizure 8 months later, despite anticonvulsant treatment. He had no recurrence of other symptoms. Author comment: "According to the Naranjo causality scale . . . the adverse effects were probably due to metoprolol." Ahmed AIA, et al. Sleep disorders, nightmares, depression and anxiety in an elderly patient treated with low-dose metoprolol. General Hospital Psychiatry 32: 646e5-646e7, No. 6, Nov-Dec 2010. Available from: URL: http:// 803046911 dx.doi.org/10.1016/j.genhosppsych.2010.04.008 - Netherlands
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Reactions 15 Jan 2011 No. 1334
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