Suicidality associated with betahistine: A rare case report and systematic review of histaminergic drug-induced depression
Jiong Tang, Yuqi Zeng, Xiaoli JiangRationale:
Drug-induced suicidality is a severe and frequently overlooked area within pharmacovigilance. While the traditional focus has centered on psychotropic medications, non-psychotropic drugs acting on histamine receptors may also induce depression and suicidality through central nervous system effects.
Patient concerns:
A 33-year-old male presented with a chief complaint of “dizziness for 1 week.” His dizziness improved after taking a betahistine hydrochloride oral solution, but he subsequently developed symptoms including low mood, emotional detachment, and suicidal ideation.
Diagnoses:
Given the close temporal relationship between drug intake and symptom onset, rapid improvement after withdrawal, and assessment by the Naranjo scale and World Health Organization–Uppsala Monitoring Centre system, the depressive symptoms with suicidality were preliminarily judged to be “probable” betahistine-associated adverse reactions (grade 1 [mild]).
Interventions:
Betahistine was discontinued immediately and replaced with difenidol hydrochloride tablets to manage the dizziness.
Outcomes:
Suicidal ideation resolved completely within 2 days of betahistine discontinuation. No recurrence of psychiatric symptoms was reported during the 3-month follow-up period.
Lessons:
This case emphasizes the need for clinicians and pharmacists to move beyond the cognitive bias that only psychotropic drugs carry a significant suicide risk. Vigilance for potential neuropsychiatric adverse reactions, such as depression and suicidality, should be maintained for all drug classes, particularly for non-psychotropic agents acting on histamine receptors. Timely recognition and drug discontinuation are crucial to ensure patient safety.