Abstract Details

Title Olfactory Hallucinations as a Unique Presentation of Anti-depressant Discontinuation Syndrome

Topic General Neurology

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-048

Objective NA

Background Discontinuation syndromes have been reported following abrupt cessation of antidepressants such as SSRIs and TCAs. Symptoms include insomnia, nausea, imbalance, sensory disturbance, and hyperarousal. Infrequent symptoms include a shock-like sensation, delirium and mania. Even rarer are visual and auditory hallucinations, which has been described in one case report. To the best of our knowledge, there have been no reported cases of olfactory hallucinations as a symptom of SSRI discontinuation syndrome.

Design/Methods A 49 year old woman presented with complaints of dizziness, episodes of transient alterations in consciousness, and “horrific smells” of mold and fire. Her neurological examination and computed tomography (CT) of the head were negative for acute findings. She was offered admission for further workup but declined, however, returned the following day with the same complaints as well as amnesia and confusion. Further workup including MRI of the brain, prolonged EEG, and lumbar puncture were negative for structural abnormalities, seizures, or infection. She was discharged home on anticonvulsants with concerns for seizures. She returned to the hospital the following day with recurrence of symptoms. Further history at that time revealed that patient had abruptly discontinued paroxetine two weeks prior to presentation. She was restarted on paroxetine and discharged home. At a follow-up visit with her primary care three days later reported cessation of any olfactory hallucinations.

Results A characteristic SSRI discontinuation syndrome appears to exist and is described with symptoms starting in the first 2 weeks after abrupt discontinuation of SSRIs. Serotonin is known to increase synaptic activity in olfactory bulb glomeruli however the mechanism by which it causes olfactory hallucinations is not established.

Conclusions We describe a unique case of antidepressant discontinuation syndrome with an initial presentation of olfactory hallucinations.

Authors/Disclosures
Shweta Varade, MD (Lakeridge Health) PRESENTER	Dr. Varade has nothing to disclose.
Casey J. Judge, DO	Dr. Judge has nothing to disclose.
Megan C. Leary, MD	Dr. Leary has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Boston Clinical Research Institute. Dr. Leary has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Baim Clinical Research Institute. Dr. Leary has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Syneos Health. Dr. Leary has received publishing royalties from a publication relating to health care.
Preet M. Varade, MD (Lehigh Valley Hospital - Cedar Crest)	Dr. Varade has nothing to disclose.

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