28th National Clinical Education Symposium Presentation Abstracts

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PP-43 Progressive Neurocognitive Decline in Midlife Following Long-Term Polysubstance Use: A Case Report - Page 241
Ezgi Şişman, İlay Dalkıran

PP-45 Dual Mood Stabilizer Treatment in a Severe, ECT-Resistant Schizoaffective Disorder: A Case Report - Page 243
Ezgi Şişman, İlay Dalkıran

PP-49 A Case of Recurrent Depression Associated With Undisclosed Kleptomania - Page 245
Ezgi Şişman, İlay Dalkıran

PP-50 Beyond Nothingness: A Case of Immortality Delusion in Cotard Syndrome - Page 246
Özgü Şişman, Erdem Kettaş

PP-51 Reversible Blurred Vision Following Sertraline Use Despite Normal Ophthalmologic Examination: A Case Report - Page 248
Özgü Şişman, Erdem Kettaş

PP-52 Escitalopram-Induced Facial Hyperpigmentation and Unilateral Periorbital Edema: A Rare Case in the Presence of Dermatological and Systemic Vulnerability - Page 250
Özgü Şişman, Erdem Kettaş

21 APRIL 2026, TUESDAY
PP-41 Atomoxetine-Induced Akathisia in an Adult Patient Using Fluoxetine: A Cautionary Case Report for Drug Interactions

PP-41 Atomoxetine-Induced Akathisia in an Adult Patient Using Fluoxetine: A Cautionary Case Report for Drug Interactions

İldeniz Tolga Uzun1, Aslı Aytulun1, Eren Yıldızhan1, Mustafa Nuray Namlı1

1. Bakırköy Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, 3rd Psychiatry Department, Istanbul, Türkiye

DOI: 10.5080/61upk.ozt526 Page 239
OBJECTIVE:Atomoxetine is a non-stimulant approved by the FDA for the treatment of attention-deficit/hyperactivity disorder in patients aged 6 years and older. Medication induced akathisia is a rare adverse effect of atomoxetine, and this case report describes akathisia that developed following atomoxetine use. CASE (The patient consent must be provided and specified with appropriate terms.):A 49-year-old female patient with a 20-year history of major depressive disorder had been receiving fluoxetine 60 mg/day. Atomoxetine 60 mg/day was added to the treatment regimen as an augmentation strategy to improve cognitive symptoms. On the sixth day, she developed restlessness, inability to remain still, a constant urge to move, and involuntary motor movements. With worsening symptoms, she admitted to our emergency department three times; benzodiazepine and propranolol were administered respectively, and fluoxetine and atomoxetine were discontinued. At her last admission, persistent akathisia and suicidal ideation were noted, and she was hospitalized for suicidal risk with preliminary diagnoses of medication-induced akathisia and recurrent depressive episode. Treatment with mirtazapine 30 mg/day, diazepam 15 mg/day, and propranolol 60 mg/day was initiated; by day four, the BARNES Akathisia Rating Scale score decreased from 13 to 0, after which diazepam and propranolol were discontinued, and mirtazapine dose was increased. (Written informed consent was obtained for the publication of case) DISCUSSION:Two cases of atomoxetine-induced akathisia have been reported in the literature, both in young patients; our case suggests that atomoxetine may also cause akathisia in adults. Atomoxetine is primarily metabolized by cytochrome CYP2D6, and fluoxetine is a potent CYP2D6 inhibitor. Their combination may increase atomoxetine levels, posing a risk for akathisia.Therefore, a lower starting dose and close monitoring are recommended when atomoxetine and fluoxetine are used in combination. In our case, the concomitant use of both drugs increased the risk of akathisia. Keywords: Adverse effects, akathisia, atomoxetine, depression, fluoxetine