HYPEROSMIA IN A WOMAN WITH ATYPICAL
DEPRESSION. HIS DISAPPEARANCE WITH THE IMPROVEMENT OF THE DEPRESSION. (Updated
and ended on January 2005)
Renato Cocchi, a neurologist and a medical
psychologist.
(Six other articles on this topic)
Summary.
In a woman of forty-eight years with
annual depressive relapses from at least seven years, the current depression,
with hyperosmia, doesn't respond to the drug therapy with amitriptyline and
alprazolam.
An antistress drug therapy, with also
chlomipramine 10mg/daily as a tricyclic antidepressant, after 55 days has
driven to a clear improvement of the depression, and the disappearance of the
hyperosmia. There is an attempt to understand the relationship between atypical
depression and hyperosmia, by suggesting the hypothesis that both are coming
out from a stress condition.
Key words: Atypical depression,
hyperosmia, stress, drugs, antistress therapy, antidepressant therapy.
Drug Modulation of stress reactions.
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It came to my observation a case of atypical
depression that, among the other symptoms, it showed even hyperosmia. I thought
that it was worth to report it either for the characteristics of the
depression, either because the trouble of the smell sense, although present,
did not have been referred as a prominent and particularly unbearable symptom,
either finally for the possible link between depression and hyperosmia.
Some literature on the
matter.
The hypersensitivity of the sense of smell,
termed even hyperosmia, is much less frequent than the loss of the same. Women
in pregnancy usually have this symptom. The hyperosmia could be a psychosomatic
reaction. This last seems more easily develop in persons who have a histrionic
personality with exaggerate search for attention and dramatic behaviour. Of
course there are hyperosmias without any psychosomatic reaction, in a narrow
sense.
In migraine forms there may be an aura of
the hyperosmic type (Seymor, 1996).
The relationship between hyperosmia and
depression is elusive. In facts, there can be secondary depression to chronic hyperosmia
(Watson, 2000). Depression and hyperosmia can coexist (Henkin, 1990), but it is
hard we can establish a relationship of cause and effect between these two, in
this order.
In the four cases trouble of the sense of
smell I published (Cocchi 2002; Cocchi, 2004a, 2004b and 2004c) in the first
three cases hyperosmia was reported. In all four, to the basic therapy it has
always added even an antidepressant drug because at the first visit, evident
symptoms of depression, at least secondary depression, were detected.
Surely in my 3rd and 4th cases ( Cocchi
2003b and 2004c ) the depression started previously to the onset of the trouble
of the smell sense, but in the fourth case there was not hyperosmia.
The case history.
5 June 2004, the first visit. F, of
forty-eight years, with four sons.
She is depressed, since some months. In the
last seven years she had at least one depressive episode every year, without
any seasonal coherence, even if usually it happened in spring.
In the first year of life she had milk crust
for twelve months. She ate a few and was pale. I did not get information on her
embryonic and fetal life, and not exact information on her birth. At school she
was doing better in Italian.
Her current depression is of an asthenic
type. She is feeling without any willingness. Now she thinks that there is a
link with a hormonal disorder from premenopause according to her hot flashes,
even if the menses appear still every twenty-eight days. Perhaps she had several
euphoria moments, but she never had a true maniacal phase.
She feels the need to speak with other
people, but she inclines to go not out from her house. Curiously, she doesn't
succeed to cry. When a child, she was not a timid and reserved girl, but she was
a jolly. Now she has difficulty in falling asleep and wakes up too early
morning, doesn't suffer from any headache. She has tachycardia and air hunger.
Her personality is of a harmonic type, without histrionic traits. Currently she
is taking an antidepressant-anxiolythic drug therapy with amitriptyline 20mg
and alprazolam 0.55mg.
Problems of fluctuating half-brain
dominance: She says that "she thinks too without willing it". She has
envy feelings against other persons. To the test: " Which is the opposite
of the colour Red?" she answers: White. She has indecision moments, and
any choice, only because sort, becomes at once worse than the alternative
choice. She not does bad dreams.
Stress problems: Some days she is pale.
About eating, she has difficulties because she feels without strengths.
Feelings of mediastinal oppression and lump in the throat occur. Currently she
does non eat sweet things but she appreciates the meat or cube broth, and she
never tasted the milk. She bears badly both the heat and the cool, as well as
light, noise and confusion. Drooling during the sleep does not occur and she is
never talking there. Nighttime bruxism is not reported but diurnal dental shut
or bruxism.
Usually she wakes up tired and she doesn't
want to get up. In the mornings she feels more confused, and she has
difficulties to do anything.
She doesn't have disbandment feelings,
but recently she had fainting feeling. Sometimes she has some dyslalias. She
suffers from nausea, stomachache, colic and diarrheas. Oversweating does not
occur but frequent need to urinate, and sudden asthenias.
Information through the visual channel
emotionally excites her more than that through the auditory channel.
Premenstrual syndrome does not occur, and her hair is not fat.
Trouble of the sense of smell: She has
hyperosmia, as it happened during her pregnancies.
Test therapy (daily doses, by the oral via):
Glutamine 125mg; Pyridoxine 75mg; Carbamazepine 100mg; Chlomipramine 10mg;
Bromazepam 0.6mg.
31 July 2004, the first checkup after nearly
two months of drug therapy. She did a house moving. She says she is less
depressed, and cried two or three times. Now she is eating better, she sleeps
better (at least five hours of sleep, but she inclines to wake early, about on
five in the mornings. Her physical energy and willing recovered and she is
happier and more serene and she feels more tonic. Currently she is going mostly
out of the house.
Problems of fluctuating half-brain
dominance: She feels her head more clear. During that time she had fewer
moments of indecision and fewer feelings of envy.
Stress problems: Hot flashes are not
missing. Perhaps she has fewer days of pallor, and reduced eye sockets. The
mediastinal oppression and lump in the throat disappeared. The nausea stopped.
Now she bears better light, noise and confusion. Faint feelings did never
occur. The early-morning confusion went down and so she succeeds to do better
his housework. Tachycardia and air hunger missed. Not more stomachache, colic
and diarrheas came out, on the contrary she has become a little constipated.
Not more need to urinate frequently; Sudden asthenias did not remain.
Trouble of the sense of smell: Hyperosmia
went out.
Therapeutic variation (daily doses, by the
oral via): Glutamine 186mg; Bromazepam 0.7mg.
First 10 days of January 2005, the second
checkup after seven months of drug therapy.
She affirms now she is no more depressed.
Her weeping missed, and she overcame well the adaptation to the new house.
Currently she eats better and sleeps well ( at least 6-7 hours of sleep, with
awakening about 6.30 in the mornings). She recovered physical energy and
willingness, and came back a little overactive. Now she is more happy and
serene, and goes regularly outside her house.
Trouble of the sense of smell: The hyperosmia
did not appear anymore.
Problems of fluctuating half-brain
dominance: Her head is now without intrusive thinking. The difficulty to decide
ran out and so too the feelings of envy.
Stress problems: Hotflashes decreased, but
she is near her menopause. Recently she has fewer days of pallor, and fewer eye
sockets. Not more mediastinal oppression and the lump in the throat occur. The
nausea stopped. She recovered her normal tolerance to the light, the noise and
the confusion. Her feelings of fainting did disappear. Not more early-morning
derangement and she succeeds normally to do the housework. Tachycardia and air
hunger missed. Her bowel function is now regulated as well as the emptying
rhythm of the bladder. Not more sudden asthenias occurred.
Other: Even in past, she has always been
overactive and perhaps had periods of modest euphoria, which made her anxious
for fear of the depressive relapse. In comparison to other experienced drug
therapies, she thinks that the current one was not heavy.
No therapeutic variation.
Discussion.
There are some elements to be recalled for a
better understanding of this case history.
1. The patient has not any histrionic
personality, and the hyperosmia is not of a psychosomatic type.
2. In this woman, the hyperosmia already
appeared in pregnancy, then disappeared and therefore even now could be a
functional, reversing trouble.
3. Lately the hyperosmia came out in a
depressive condition, without any pregnancy.
4. Depression did not respond to the current
antidepressant-anxiolytic drug therapy, with amitriptyline and alprazolam.
5. The patient had a basic easiness with a
tendency to depressive answers increasing with her age, and a specific
fragility in some brain area of the sense of smell.
After 55 days even antistress drug therapy,
but with substitution of the amitrityline (a tricyclic antidepressant) with
reduced dosing of chlomipramine (a tricyclic antidepressant too) and the
alprazolam with the bromazepam (both benzodiazepines) these results followed:
1. The antidepressant action was much more
marked and widened.
2. The patient missed the hyperosmia, which
then was a functional, reversing symptom.
We could deduce that:
1. The current depression did not relate
only to mechanisms of serotonin and noradrenaline, neurotransmitters on which
both amitriptyline and chlomipramine were acting.
2. The current type of depression is
unusual, an atypical depression.
3. The hyperosmia has poor relationships or
no relationship with serotonin and noradrenaline.
4. The relationship between depression, in
wider sense, and hyperosmia could be simply of coincidence, being perhaps the
stress as the cause of both.
A relationship with the three cases I
described (Cocchi 2002; Cocchi 2004a; Cocchi 2004b) does not help much to
understand, because there the hyperosmia was one trouble of the sense of smell,
with presence in all three even of anosmia.
In this present case instead the hyperosmia
is the only symptom of a trouble of the smell, a thing already possible and
described in the literature (Henkin, 1990).
Five months after the first checkup, even the depression has been
overcome but drugs did not stop, at the moment, for the aim to stabilize the
result.
This case history report ends here.
(Six other articles on this topic)
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 second case with
hyperosmia-anosmia with ageusia (a taste trouble), improved following an
antistress drug therapy. Juanuary
2004a.<www.stress-cocchi.net/Other8.htm>.
Cocchi R.
A third case of anosmia-hyperosmia with
ageusia, following stress and possible viral infection, improved with an
antistress drug therapy. January 2004b.
<www.stress-cocchi.net/Other7.htm>.
Cocchi R.
A fourth case of anosmia, with cacosmia
and ageusia, treated with antistress and antidepressant drug therapy. May
2004c. <www.stress-cocchi.net/Other10.htm>.
Henkin RI. Hyperosmia and depression
following exposure to toxic vapors. JAMA. 1990, 264: 2803.
Seymour D. Managing Migraines in Active
People. The Physician and Sports Medicine. vol 24 - No. 12 - December 1996.
Watson, Lyall. Jacob's Organ and the
Remarkable Sense of Smell. New York: W. W. Norton & Company, 2000.
Posted on Internet on 19 August 2004.
Copyright by Renato Cocchi, 2004.
Authotr's address: Dr Renato COCCHI, via Rabbeno, 3
42100 Reggio Emilia
renatococchi@libero.it
Drug Modulation of stress reactions.
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