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.