A 38-year old woman developed secondary Cotard's Syndrome (CS) after having a lumpectomy to remove a tumor in her breast. Secondary Cotard's Syndrome simply means that the patient has no previous reportings of psychological disorders. Before the operation her husband reported that she became "more ruminative and less active," expressing depressive symptoms, but she told him she was just worried about having cancer. However; after the operation her depressive symptoms intensified and worsened within one month as she refused to go to work because she was feeling unwell. She started to show symptoms of a CS patient in the Germination Stage. She complained of feeling stressed, anxious, less concentrated and believed that she had a malignant (fatal) cancer despite scientific evidence. Her primary care physician prescribed her 20 mg/day of escitalopram. After 5 months of this prescription minimal recovery occurred, so she was sent to other doctors to help with her treatment.
The patient showed symptoms of depression and delusions. She had a loss of energy, crying spells, diminished ability to concentrate and impaired functioning. The patient showed delusional symptoms of Cotard's Syndrome. She believed that she "doesn't exist anymore" and is "dead because I've lost my organs." She also believed that her anesthesia killed her and turned her into a zombie, and because she was dead she believed she couldn't kill herself.
The patient was then diagnosed with Major Depressive Disorder with Psychotic Features per DMS-IV, but her depressive symptoms were less pervasive and severe than her delusions. The Hamilton Rating scale for Depression (HAM-D) was used to determine the severity of her depression and she received a score of 25. To help treat her symptoms, she was prescribed 5mg/day of aripiprazole alongside her 20 mg/day of escitalopram.
After one week of this treatment, her depressive symptoms and delusions improved slightly. The dosage of aripiprazole was increased to 10mg/day to better match the 20mg/day of escitalopram. In the second week, her HAM-D scored reduced to 19 showing the progress she was making on the aripiprazole/escitalopram combination. After the fifth week, the CS symptoms remitted and her HAM-D score further decreased to 11, showing how effective the treatment is. At the end of the second week, the patient's HAM-D score decreased to only 6 showing full remission. After three months of therapy, the patient was put on equal doses of escitalopram and aripiprazole (10mg/day) and fully recovered in October 2013.
This case shows that a combination of escitalopram and aripiprazole can be used to treat secondary CS in future patients, as well as patients with primary CS.
The patient was then diagnosed with Major Depressive Disorder with Psychotic Features per DMS-IV, but her depressive symptoms were less pervasive and severe than her delusions. The Hamilton Rating scale for Depression (HAM-D) was used to determine the severity of her depression and she received a score of 25. To help treat her symptoms, she was prescribed 5mg/day of aripiprazole alongside her 20 mg/day of escitalopram.
After one week of this treatment, her depressive symptoms and delusions improved slightly. The dosage of aripiprazole was increased to 10mg/day to better match the 20mg/day of escitalopram. In the second week, her HAM-D scored reduced to 19 showing the progress she was making on the aripiprazole/escitalopram combination. After the fifth week, the CS symptoms remitted and her HAM-D score further decreased to 11, showing how effective the treatment is. At the end of the second week, the patient's HAM-D score decreased to only 6 showing full remission. After three months of therapy, the patient was put on equal doses of escitalopram and aripiprazole (10mg/day) and fully recovered in October 2013.
This case shows that a combination of escitalopram and aripiprazole can be used to treat secondary CS in future patients, as well as patients with primary CS.