escitalopram + clonazepam (Citapure Forte)

Adverse event reporting patterns of selective serotonin reuptake inhibitors (SSRIs): disproportionality analysis using the European spontaneous reporting system.

Laino Ludovica Vittoria LV, Mascolo Annamaria A, Di Napoli Raffaella R, di Mauro Gabriella G et al.

We analysed adverse event reporting patterns associated with SSRIs using data from the European pharmacovigilance database, EudraVigilance. A descriptive analysis of individual case safety reports (ICSRs) was conducted between January 2020, 1st and December 2024, 31st. Disproportionality analysis were conducted for the two most frequently reported system organ classes (SOCs) and the three most frequently reported preferred terms (PTs). During the study period, 21,665 ICSRs reporting at least one SSRI as suspected drug were retrieved. A total of 78,132 adverse events were identified, and sertraline (N = 26,161; 33.5%) was the most reported SSRI. Most events were not serious, and the most reported criterion was Other Medically Important Condition (N = 19,603; 25.1%). The most frequent outcome was "Unknown" (N = 27,555). In the disproportionality analysis, for the SOC "Psychiatric Disorders", escitalopram and fluvoxamine showed a higher disproportionate reporting (ROR 1.08; 95% CI 1.03-1.13; ROR 1.15; 95% CI 1.01-1.31, respectively). For the SOC "Nervous System Disorders", paroxetine showed a higher disproportionate reporting (ROR 1.10; 95% CI 1.04-1.16). Headache higher disproportionate reporting with sertraline (ROR 1.17; 95% CI 1.04-1.30), while dizziness with escitalopram (ROR 1.42; 95% CI 1.25-1.61), and somnolence with fluvoxamine and paroxetine (ROR 1.86; 95% CI 1.27-2.72; ROR 1.58; 95% CI 1.33-1.89, respectively). SSRIs showed homogeneous adverse event reporting patterns, with relatively few differences in disproportional reporting between individual drugs. These results reinforce the importance of continuous pharmacovigilance monitoring.

Functional Neurological Disorder Presenting as Psychogenic Non-epileptic Seizures Associated With Recurrent Hemoptysis: A Diagnostic Challenge.

Ramadugu Rithika R, Pidikiti Chandra Varshini CV, Garrido Flores Iliana I, Cordero Peña Alesha A et al.

Functional neurological disorder (FND), previously termed conversion disorder, is characterized by neurological symptoms that are incongruent with recognized neurological or medical conditions. Psychogenic non-epileptic seizures (PNES) are among its most common manifestations; however, hemoptysis occurring in association with PNES is exceedingly rare. A 15-year-old male presented with recurrent seizure-like episodes of one-year duration that progressively increased in frequency. During episodes, he remained conscious, responsive, and able to communicate, with no post-ictal confusion, urinary incontinence, or tongue biting. The events were accompanied by recurrent hemoptysis, chest pain, and hyperhidrosis. Extensive investigations, including hematological and biochemical testing, electroencephalography, magnetic resonance imaging of the brain, autoimmune encephalitis panel, upper gastrointestinal endoscopy, computed tomography of the chest, bronchoscopy, and otorhinolaryngological evaluation, failed to identify an organic etiology. Following multidisciplinary assessment by neurology and psychiatry teams, a diagnosis of FND presenting as PNES with associated hemoptysis was established. The patient was managed with psychotherapy, psychiatric support, selective serotonin reuptake inhibitors (SSRIs), and clonazepam, with tranexamic acid administered during episodes of hemoptysis, resulting in symptomatic improvement. This case highlights an unusual presentation of FND and emphasizes the importance of comprehensive multidisciplinary evaluation in patients with PNES and unexplained hemoptysis. Recognition of this rare association may prevent unnecessary investigations, facilitate timely diagnosis, and enable appropriate psychological and supportive management.

Escitalopram Discontinuation-Related "Brain Zaps" in a Patient With Generalized Epilepsy.

Eren Halil İbrahim Hİ, Takım Uğur U

A longitudinal case report illustrating diagnostic complexity among overlapping sleep-wake phenotypes.

Martirosyan Zara Z, Whitesell Peter P

The coexistence of multiple primary sleep disorders in a single patient is uncommon and poses significant diagnostic and therapeutic challenges. We report a 45-year-old woman with severe mixed sleep apnea (OSA/CSA), NREM parasomnia (night terrors), sleep-related eating disorder (SRED), nightmare disorder (with RBD like behavior but no REM atonia on PSG), and central hypersomnolence phenotype minimally affected with PAP optimization and delayed sleep-wake phase disorder. Symptoms began more than two decades earlier and included violent dream-enactment behaviors, hypnopompic hallucinations, sleep inertia, and chronic excessive daytime sleepiness (EDS). Treatment required multi-modal therapy. Positive airway pressure therapy successfully treated sleep disordered breathing while pitolisant and solriamfetol produced the most durable improvement in daytime sleepiness. Together melatonin plus clonazepam reduced parasomnia frequency and severity. Several other agents (including prazosin, sodium oxybate, paroxetine, and modafinil) were tried and discontinued for limited benefit or adverse effects. Notably, GLP-1 receptor agonist (GLP-1 RA) therapy for obesity was followed by a substantial weight loss and coincided with resolution of SRED. Because this occurred alongside improved sleep stability, PAP adherence, behavioral adaptation, and medication changes, causality cannot be inferred. The observation may justify further study of metabolic and incretin-related pathways in sleep-related eating behaviors. Overall, this case highlights the complexity of overlapping sleep-wake disorders, the need for individualized pharmacologic sequencing, and a potential emerging role for GLP-1 agonists in SRED.