Case 1
A 26-year-old Malay female presented, with complaints of depressive symptoms for a year. She had been started initially on duloxetine which was titrated up to a dose of 60 mg. 2 mg of clonazepam was added but she could not sleep with clonazepam, and her depressive symptoms were also poorly controlled, hence quetiapine was added to aid in sleep and increase the antidepressant effects. The dose of quetiapine was gradually titrated up to 200mg at bedtime over 6 months. The diagnosis of SRED was mainly clinical. The patient walked with her eyes open, walked and ate and had no memory of the event. She ate junk food from the refrigerator while sleeping three to four nights per week. She even cut a mango before eating it. The patient could not remember any of these events after awakening. She put on 11 kg during the 6 months. This patient had no previous history of sleep walking. Quetiapine was tapered down and olanzapine 5 mg was substituted. On olanzapine 5 mg the frequency of SRED decreased but it did not go away completely. Hence the olanzapine was stopped, and clonazepam was changed to 10 mg zolpidem after which the patient could sleep. Resolution of SRED after stopping quetiapine and its relapse after introduction of olanzapine in this case confirms the role of olanzapine 5 mg/day in precipitating SRED episodes. Her physical examination was unremarkable except for an elevated BMI of 34.11kg/m2. For her depressive symptoms lithium was added.