Eur J Pharmacol ; Excessive yawning and SSRI therapy. Duloxetine-induced excessive disturbing and disabling yawning. Gutierrez-Alvarez AM. Do your patients suffer from excessive yawning? Harada K. Paroxetine-induced excessive yawning. Psychiatry Clin Neurosci ; Role of central nitric oxide in the control of penile erection and yawning.
Biochemical, neurophysiological, and behavioral effects of Wy, and other identified metabolites of the antidepressant venlafaxine. Injured temporomandibular joint associated with fluoxetine-monotherapy-induced repeated yawning.
Drug-induced yawning: a review of the French pharmacovigilance database. The role of alpha1- and alpha2-adrenoreceptors on venlafaxine-induced elevation of extracellular serotonin, noradrenaline and dopamine levels in the rat prefrontal cortex and hippocampus.
Venlafaxine-induced excessive yawning. Murphree TM. Fluoxetine-induced yawning and anorgasmia reversed by cyproheptadine treatment. Cohen AJ J. Psychiatry Repeated observations of yawning; clitoral engorgement; and orgasm associated with fluoxetine administration Klein DF Clin Psychopharmacol ; 9; 5; Modell JG Repeated observation of yawning, clitoral engorgement, and orgasm associated with fluoxetine administration.
The indifference syndrome also followed a pattern with previously described features consisting of: apathy remains stable and continuous for weeks; patient is aware of emotional restraint and is also distressed by this; diminished spontaneity in actions and speech. Resolution of both yawning and indifference after antidepressant discontinuation, and recurrence after reinitiating the medication strengthens the possibility of their drug induced nature.
Given the distress provoked by yawning and indifference in the patients described in this article, they presented questions regarding side effects directly to their physician. Previous literature reports that distress and impairment with such phenomena may vary and that patients may report such side effects only upon active investigation by the examiner.
As such, it is possible that excessive yawning and indifference may occur more frequently and are underdiagnosed. Three different antidepressants that share serotonergic effects were associated with yawning in the reported patients.
Serotonin augmentation has been associated with yawning induction both in clinical and experimental settings. Although there is conflicting evidence regarding serotonin manipulation and yawning in animals, their neurotransmission circuitry may not be similar to what is found in humans. Yawning is a behavioral manifestation in drug experiments with animals and is considered as an outcome measure for central nervous system action.
Serotonin augmentation increases yawning in cats and reduces it in rats. Noradrenalin and dopamine increases yawning in rats 8 8 Furukawa T. Yawning behavior for preclinical drug evaluation. Methods Find Exp Clin Pharmacol. In addition, human yawning regulation, especially in the paraventricular nucleus of the hypothalamus, derives from a complex chemical cascade with an imbalance still poorly understood 2 2 Walusinski O.
Also, desvenlafaxine can inhibit noradrenaline reuptake, which is another possible mechanism for this side effect. The occurrence of apathy and emotional blunting, respectively, as a behavioral and an emotional manifestation of an indifference syndrome 7 7 Sansone RA, Sansone LA.
Antidepressant induced-indifference has an unknown etiology. Two proposals to explain this side effect are: a dopaminergic reduction in basal ganglia secondary to serotonin augmentation in raphe nucleus; b frontal lobe dysfunction induced by serotonin increases. The occurrence of both excessive yawning and indifference may be the result of serotonergic increases in the midbrain, especially, the raphe nucleus and the hypothalamic paraventricular nucleus 6 6 Figueira I, Marques C, Fontenelle LF, Nardi AE, Versiani M.
Also, it is possible that patients may experience the induction of indifference as boredom and activate yawning as a behavioral manifestation expressing this emotional state. Depression can yield excessive yawning and indifference by itself misleading clinicians to evaluate them as manifestations of depression instead of attributing those as possible side effects of pharmacotherapy 2 2 Walusinski O. Excessive yawning and SSRI therapy. Int J Neuropsychopharmacol. Thus, antidepressant increases could potentially lead to worsening of yawning and indifference.
The switch to a non-serotonergic antidepressant may be a possible strategy to resolve those symptoms if the patient needs to maintain antidepressant therapy.
This case series suggest the need for more data regarding those side effects and their co-occurrence in patients treated with antidepressants.
Abrir menu Brasil. Jornal Brasileiro de Psiquiatria. Follow the instructions carefully. Ask your doctor if you have any questions. Take the extended-release capsule or tablet with food either in the morning or evening at about the same time each day. If your doctor tells you to take the medicine a certain way, take it exactly as directed. Swallow the extended-release capsule whole with fluid. Do not crush, chew, divide, or place the capsule in a liquid. If you are unable to swallow the extended-release capsule, open it and pour the medicine on a spoonful of applesauce.
Swallow the mixture of applesauce and medicine right away without chewing. Drink a glass of water so all of the medicine is swallowed. The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule.
Do not double doses. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing. If you will be taking this medicine for a long time, it is very important that your doctor check you at regular visits.
This will allow your doctor to see if the medicine is working properly and to decide if you should continue to take it. Do not start taking venlafaxine during the 14 days after you stop a MAO inhibitor and wait 7 days after stopping venlafaxine before you start taking a MAO inhibitor.
If you take them together or do not wait the proper amount of time, you may develop confusion, agitation, restlessness, stomach or intestinal symptoms, a sudden high body temperature, an extremely high blood pressure, or severe seizures. Venlafaxine may cause a serious condition called serotonin syndrome if taken together with certain medicines.
Check with your doctor first before taking any other medicines with venlafaxine. This medicine may cause some teenagers and young adults to be agitated, irritable, or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed.
Some people may have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. If you or your caregiver notice any of these unwanted effects, tell your doctor right away. Let the doctor know if you or anyone in your family has bipolar disorder manic-depressive or has tried to commit suicide. Do not suddenly stop taking this medicine without checking first with your doctor.
Your doctor may want you to gradually reduce the amount you are taking before stopping it completely. This will decrease the chance of side effects, such as agitation, confusion, headache, irritability, numbness or tingling feeling, restlessness, trouble sleeping, or unusual drowsiness or weakness.
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