Psychosis associated with sibutramine consumption: a case report
A. Gomez Prieto, A. García Gonzalez, A. Mercado Rodriguez, I. Zorrilla Martinez, A. M. González-Pinto ArrillagaIntroduction
Sibutramine is a serotonin and noradrenaline reuptake inhibitor that was withdrawn from the market due to cardiovascular and neuropsychiatric adverse effects. Nevertheless, it continues to be clandestinely marketed in “natural” weight-loss products sold online, without proper labeling, thus posing a significant health risk. Psychotic episodes related to sibutramine intake have been reported, yet they are often underdiagnosed (1,2).
Objectives
To describe a clinical case of psychosis secondary to sibutramine consumption, highlighting the recurrence of two clinically similar episodes after re-exposure and the relevance of a thorough clinical history, including over-the-counter supplements, in the differential diagnosis of first-episode psychosis.
Methods
A 33-year-old woman, with no previous medical or psychiatric history, was involuntarily admitted after a six-month history of bizarre behavior, incoherent speech, persecutory and referential delusions, anxiety, and insomnia. Routine blood tests and urine toxicology were unremarkable. Brain MRI revealed an incidental Rathke’s cleft cyst.
Results
During hospitalization, the patient disclosed chronic use of a slimming product (LiDa), later identified as adulterated with sibutramine. Following discontinuation of the product and initiation of risperidone 3 mg nightly, she showed rapid and complete remission. Two years later, after re-exposure to the same supplement, she developed a second psychotic episode with identical features, which again resolved with the same therapeutic approach.
Conclusions
Sibutramine can trigger acute psychotic episodes in individuals without prior psychiatric history, with a risk of recurrence upon re-exposure. This case emphasizes the importance of a comprehensive clinical history exploring the use of supplements and “natural” products purchased online. Identifying such hidden agents as potential triggers is crucial to avoid underdiagnosis and prevent relapses.
References
Chen SP, et al. Psychosis with herbal slimming products adulterated with sibutramine: a case series. Clin Toxicol (Phila) 2010;48:832–8. Lee J, et al. Catatonia and psychosis associated with sibutramine: a case report. Prog Neuropsychopharmacol Biol Psychiatry 2007;31:1179–82.
Disclosure of Interest
None Declared