By Courtney Brooks, MD
Virginia Commonwealth University Health Systems
9 – Management of Depression in a Patient with Brugada Syndrome: A Case Report
Courtney Brooks, MD; Sherin Moideen, MD
I had the opportunity to present a case report at the Fall meeting. I discussed the case of a female patient with a history of treatment-refractory depression who experienced a syncopal episode while on a supratherapeutic dose of nortriptyline.
Workup confirmed a diagnosis of Brugada syndrome, which is a cardiac condition that results in an increased risk for ventricular arrythmias and sudden cardiac death. Many commonly prescribed psychotropic medications have been found to induce electrocardiographic abnormalities and sometimes fatal arrythmias in patients with Brugada syndrome. Once Brugada syndrome was confirmed in our patient, she underwent TMS treatments and was later started on Mirtazapine along with close collaboration with our cardiology colleagues.
Treatment options are limited in patients with comorbid psychiatric illness and Brugada syndrome. This case illustrates TMS may be a beneficial nonpharmacologic treatment option for these patients. Also, mirtazapine appears to be safe pharmacologic option, though information is limited.
Future studies can increase data on safe pharmacologic treatment options for patients with comorbid Brugada syndrome and psychiatric illness.
