title: Hypomania after augmenting venlafaxine and olanzapine with sarcosine in a patient with schizophrenia: a case study.
abstract: Glutamate is the main excitatory neurotransmitter in the central nervous system. Dysfunction of the glutamatergic system plays an important and well-established role in the pathogenesis of schizophrenia. Agents with glutamatergic properties such as N-methyl-D-aspartate receptor coagonists (ie, glycine, D-cycloserine) and glycine transporter type 1 inhibitors (eg, sarcosine, bitopertin) are investigated in schizophrenia with special focus on negative and cognitive symptomatology. In this article, we describe a case of a 34-year-old woman with diagnosis of schizophrenia with persistent moderate negative and cognitive symptoms, a participant of the Polish Sarcosine Study (PULSAR) treated with olanzapine (25 mg per day) and venlafaxine (75 mg per day). During ten weeks of sarcosine administration (2 g per day) the patient's activity and mood improved, but in the following 2 weeks, the patient reported decreased need for sleep, elevated mood, libido and general activity. We diagnosed drug-induced hypomania and recommended decreasing the daily dose of venlafaxine to 37.5 mg per day, which resulted in normalization of mood and activity in about 1 week. After this change, activity and mood remained stable and better than before adding sarcosine, and subsequent depressive symptoms were not noted. We describe here the second case report where sarcosine induced important affect changes when added to antidepressive and antipsychotic treatment, which supports the hypothesis of clinically important glutamate-serotonin interaction.
authors.affiliation: Department of Affective and Psychotic Disorders, Medical University of Łódź, Central Clinical Hospital, Łódź, Poland.
authors.forename: Dominik
authors.initials: D
authors.lastname: Strzelecki
authors.affiliation: Department of Affective and Psychotic Disorders, Medical University of Łódź, Central Clinical Hospital, Łódź, Poland.
authors.forename: Justyna
authors.initials: J
authors.lastname: Szyburska
authors.affiliation: Department of Affective and Psychotic Disorders, Medical University of Łódź, Central Clinical Hospital, Łódź, Poland.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Kotlicka-Antczak
authors.affiliation: Department of Affective and Psychotic Disorders, Medical University of Łódź, Central Clinical Hospital, Łódź, Poland.
authors.forename: Olga
authors.initials: O
authors.lastname: Kałużyńska
keywords: MNDA receptor; glutamatergic system; serotoninergic system