A CASE OF MELANCHOLIC
DEPRESSION WITH HYPOSMIA, AGEUSIA, CACOSMIA AND TINNITUS. ITS EVOLUTION WITH
ANTISTRESS AND ANTIDEPRESSANT DRUG THERAPY.
Renato COCCHI, a neurologist and a medical
psychologist.
Affiliation: CTR,
via F.lli Cervi 59/E, 42100 Reggio Emilia
(Six other texts about smell troubles)
Summary.
In 58 years old woman, who was under a
stressful period, a possible parainfluenzal high fever drew to anosmia, ageusia
and cacosmia. Seven months later, being under depression and hyposmia, ageusia
and cacosmia started an individually tailored drug therapy. Twenty-six days
later with antistress and antidepressant therapy the depression started to give
up, the cacosmia did not reappear and the initial hyposmia transformed into a
hyperosmia. The author considers this last as a progress in the way of
recovering the sense of smell.
Key words: Anosmia,
hyposmia, hyperosmia, cacosmia, ageusia, tinnitus, depression, stress, drug
therapy
Drug modulation of stress reactions.
It arrived in outpatients' clinic a woman
with a major depression, melancholic type, and a previous anosmia, ageusia,
with cacosmic episodes following a high fever with a maximum of 39.8° C..
I wanted give at once a report after the
first checkup, because the course of the smell trouble is modified into a
hyperosmic sense. I previewed already this and I reported it with possible
explanation (Cocchi, 2003 ).
The case history.
The end of September 2004, first
consultation.
Female, of 58 years, a teacher, marry, far
from the husband, who is working abroad. She is badly since seven months, when
she had a high fever with a maximum of 39.8°C, with pharyngal pain, followed by
anosmia and ageusia, with cacosmia episodes. When she had this high fever, she
was in particular stressful condition. She did not yet resume her school
teaching.
The NMR stated little subcortical infarcts
as frontal-parietal, right parietal-insular region and both sides' pallid
regions.
The trouble of the sense of smell: Currently she has not hyperosmia, but she had it in
past, after therapy with an OTC polyvitaminic compound and another compound
drug of vitamins B1+B6+B12. Now she is hyposmic and she smells better desserts,
the cabbage, the coffee, and fishes.
Depressive symptoms: Now she has a depressed mood, cries easily, sleeps
badly, and she is awaking early in the morning, too assuming lorazepam 1mg in
the evening. She inclines to avoid doing housework because they make her
confused. Lately she has a one-side diffused headache. She is suffering from
the idea to come back to the school. She doesn't look for milk or dairy's
products. Sometimes she has mediastinal oppression, some air hunger, some lump
in the throat.
Troubles of the half-brain dominance: She has intrusive thinking. Just she wakes, at once
her brain starts to think by itself. She has bad thoughts, against her elderly
mother who cannot leave the bed, and she feels guilty for them. To the test
"Say me the opposite of the colour Red?", she answered: White. To
find the right words is not an easy task for her. Her concentration does not
work well.
Stress symptoms: She suffers from the cold, likes sweet things, but
has normal greediness for the meat bullion. Some days she has pallor days with
the eye sockets. The African wind (the sirocco) makes her badly. Usually she
has some dyslalias, nighttime cramps, and she wakes up a little tired. In the
mornings, she isn't hungry at once. She is better in the morning. She has
sudden asthenias, for no apparent reasons. During the sleep, she doesn't
slobber, does not rest in the afternoon, dental shut is rare. She bears badly
the noise, has rare feelings of disbandment, no faint feelings.
Other symptoms: Her bowel function works regularly. She sweats a
few. Perhaps she has a light memory deficit, but a tinnitus of rustle type.
Temptative therapy (daily doses, by the oral
via): Glutamine 250mg, pyridoxine 75mg; carbamazepine 100mg, chlomipramine
10mg, lorazepam 1mg.
October 2004, the first checkup after 26
days of drug therapy.
The trouble of the sense of smell: She started a hyperosmia phase, for the coffee, some
deodorants and perfumes, exhausting gas, onions. Cacosmic feelings got over.
She doesn't know if her taste is improving.
Depressive symptoms: Anxiety and depression did not worsen. In the last
week she cried of less, and she has fewer moments of a bad mood. Her sleep does
not run right. Feelings of air lack go on. She is afraid by the idea of coming
back to the school teaching. No she has fewer punctures in the head. Her
husband found her more calm. At home, she succeeds to do some more housework.
Troubles of the Half-brain dominance: Her head has fewer intrusive thoughts. Now, she has a
reduced onset of bad thoughts against her elderly and sick mother. She has
recovered reading.
Stress symptoms: She bears always badly the noise, eats some more,
digests a little better. When she has slept better, she is less tired all the
day. She is not feeling more deflated. She did not observe any skin variation.
Feelings of disbandment got over.
Other symptoms: The tinnitus did not improve.
Therapeutic variation (daily doses, by the
oral via): Stopped chlomipramine and substituted with amitriptyline +
perhenazine 10+2mg; carbamazepine 300mg.
Discussion.
Links between depression and smell troubles
are not new (Cocchi 2004).
By referring to the same patient, the
trouble of the senses of smell and taste came out following an episode of high
fever (perhaps a flu like type) in a condition of prolonged stress.
As for the DSM-IV, this depressive form
could be classified as Major Depressive Disturb, Single Episode, Severe,
without any Psychotic Manifestation (F322), with Melancholic Manifestation. So,
even if it drives to the doubt that this classification does not account for
its atypical aspects.
The drug's intake period, moreover to low
dosing, was modest. In spite of that, apart from some improvements of the
depression and of symptoms linked to the troubles of the half-brain dominance
(her head cleared away and improved the concentration with resumption of
reading), the more interesting fact has verified about the sense of smell.
The cacosmia, - a probable substituting
hallucination of the temporary interruption of the specific sensory flow
specifies (sensory deprivation) -, did not appear any longer.
In its birth, a component of altered
brain circulation seems possible following the NMR report for which little
subcortical infarcts as frontal-parietal, right parietal-insular region and
both sides' pallid regions were detected
It is not said however that is an exhaustive
explanation. Why then it is an unpleasant hallucination and not a pleasant one,
it makes an other matter that would deserve a deeper consideration.
Of greater interest is the fact that the hyposmia
modified into hyperosmia.
Still a time it seems that to come back to
the normal smelling (if we can come back to it) we should do a walk backwards:
--> anosmia --> hyposmia --> hyperosmia --> smelling normalcy.
In this patient the hyperosmic phase is
particularly intense, for the coffee, some deodorants and perfumes, exhausting
gas, onions.
As for more intense odours, coffee and
exhausting gas, they were reported by a patient with hyperosmia linked to
headache (Cocchi, 2004) and by another patient with hyperosmia (Cocchi, 2004),
while "gasoline" byproducts had unbearable smell for a female patient
(Cocchi, 2002 ).
Conclusions:
The short-lasting therapy with antistress
and antidepressant drugs needs even here a great caution. Now, the depression seems
to have yet started to give up, while the cacosmia did not reappear and the
initial hyposmia transformed into hyperosmia. The author considers this last a
progress along the sense of smell improvement.
(Six other texts about smell troubles)
References:
Cocchi R. An anosmia-hyperosmia case with
hypogeusia, from probable stress, Improved following an antistress drug therapy. June 2002
<www.stress-cocchi.net/Other1.htm>.
Cocchi R. A third case of anosmia-hyperosmia
with ageusia, following stress and possible viral infection, improved with an
antistress drug therapy. (Updated June 2004) Gennaio 2004. <www.stress-cocchi.net/Other7.htm>.
Cocchi R. Hyperosmia
in a woman with atypical depression. His disappearance with the improvement of
the depression. Agosto 2004.< www.stress-cocchi.net/Other13.htm>
Cocchi R. Hyperosmia, and headache's fits from heavy, olfactory stimuli
in a 35-years-old man of 35 years. An approach with antiepilectic and antistress
drugs. Ottobre 2004.< www.stress-cocchi.net/Other14.htm>
Posted on Internet on 7 novembre 2004. Copyright by
Renato Cocchi, 2004.
Author's address: dr. Renato COCCHI, via Rabbeno, 3
42100 Reggio Emilia
email: renatococchi@libero.it
Drug modulation of stress reactions.