title: Delayed multifocal recurrent stress-induced cardiomyopathy after antidepressants withdrawal.
abstract: Stress-induced cardiomyopathy is an acute disease characterized by a large left ventricular apical dyskinesia ("apical ballooning"), triggered by intense emotional or physical stress, acute illnesses or, rarely, by alcohol or opiates withdrawal. Connection to stress and apical asynergy suggest a catecholamine-mediated pathogenesis. We recently observed a typical apical stress-induced cardiomyopathy, arising two weeks after a long-lasting antidepressant treatment withdrawal and recurring, a week later, with evidence of inferior wall akinesia. The reported case has several unusual features: 1) both episodes were not preceded by relevant triggering event (except antidepressant discontinuation); 2) early heterozonal relapse was observed; 3) the latency between antidepressant discontinuation and stress-induced cardiomyopathy onset is unusually long. The lack of relevant triggering stress and the evidence of multifocal asynergies could support the hypothesis of a non-catecholaminergic pathogenesis. Moreover, the long latency after antidepressant withdrawal may suggest that prolonged antidepressant treatments may have delayed pathological consequences, possibly related to their known neuroplastic effects.
authors.affiliation: CNR Institute of Clinical Physiology, Pisa, Italy; EXTREME CENTRE, Scuola Superiore Sant'Anna, Pisa, Italy. Electronic address: c.marabotti@alice.it.
authors.forename: Claudio
authors.initials: C
authors.lastname: Marabotti
authors.affiliation: UO Cardiovascolare - UTIC, Ospedale della Bassa val di Cecina, Cecina, Italy.
authors.forename: Elio
authors.initials: E
authors.lastname: Venturini
authors.affiliation: CNR Institute of Clinical Physiology, Pisa, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Marabotti
authors.affiliation: CNR Institute of Clinical Physiology, Pisa, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pingitore
mesh_terms: D000368:Aged; D000928:Antidepressive Agents / Q000009:adverse effects*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D013375:Substance Withdrawal Syndrome / Q000150:complications*; D054549:Takotsubo Cardiomyopathy / Q000139:chemically induced* / Q000175:diagnosis
chemical_list: D000928:Antidepressive Agents
keywords: Antidepressant drugs; Apical ballooning; Stress-induced cardiomyopathy; Tako-tsubo syndrome; Withdrawal syndrome