title: Severe agitation in depression precipitated by dasatinib.
abstract: We describe a case of a man with chronic myeloid leukaemia who achieved remission through dasatinib therapy after being unable to tolerate several tyrosine kinase inhibitor (TKI) regimens due to severe physical side effects. However, this coincided with the onset of distressing agitation, insomnia and motor restlessness leading him to take a large zopiclone overdose. Start of appropriate therapy with a clonazepam, venlafaxine and mirtazapine combination led to a rapid improvement in symptomatology. We discuss the differential diagnosis and review the literature of neuropsychiatric complications of TKIs. This case serves as an illustrative reminder that in cases of complicated agitation referral to specialist mental health teams for rational psychopharmacological management is advised.
authors.affiliation: Epsom Community Mental Health Recovery Service, Surrey & Borders NHS Partnership Foundation Trust, Surrey, UK.
authors.forename: Musa Basseer
authors.initials: MB
authors.lastname: Sami
authors.affiliation: Mole Valley CMHRS, Surrey & Borders NHS Partnership Foundation Trust, Surrey, UK.
authors.forename: Farida
authors.initials: F
authors.lastname: Yousaf
authors.affiliation: Epsom Community Mental Health Recovery Service, Surrey & Borders NHS Partnership Foundation Trust, Surrey, UK.
authors.forename: Antonio
authors.initials: A
authors.lastname: Fialho
mesh_terms: D053961:Azabicyclo Compounds / Q000008:administration & dosage; D000069439:Dasatinib; D003863:Depression / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D003937:Diagnosis, Differential; D004305:Dose-Response Relationship, Drug; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010879:Piperazines / Q000008:administration & dosage; D011505:Protein-Tyrosine Kinases / Q000037:antagonists & inhibitors; D011595:Psychomotor Agitation / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D011743:Pyrimidines / Q000009:adverse effects* / Q000627:therapeutic use; D013844:Thiazoles / Q000009:adverse effects* / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
chemical_list: D053961:Azabicyclo Compounds; D006993:Hypnotics and Sedatives; D010879:Piperazines; D011743:Pyrimidines; D013844:Thiazoles; C515050:zopiclone; D011505:Protein-Tyrosine Kinases; D000069439:Dasatinib