This is most likely a serotonin-mediated effect in this case.
Mr S. is a 32-yr-old computer analyst who began treatment for a major depressive episode with 10 mg}d fluoxetine. His depression responded rapidly to treatment, however following 1–2 wk therapy, he began to experience excessive daytime yawning. The patient estimated that yawning occurred 20–30 times daily. The yawning was not associated with sedation or a feeling of needing sleep. He was disturbed by this effect, as yawning occurred during business meetings and interpersonal interactions. This led the patient to become concerned that others would interpret this as a sign of boredom or lack of attention and interest.
Because of inhibition of ejaculation, fluoxetine was discontinued after 9 months. At the patient’s request, no medications were given during the following 3 months and yawning quickly diminished to 3–4 times per day.
The subject’s depression recurred however, and 10 mg}d citalopram was prescribed. Excessive yawning resumed 1–2 wk following citalopram initiation at a frequency of 20–30 times per day. Again, adverse sexual effects occurred and citalopram was discontinued. Treatment with 100 mg}d bupropion SR was begun and the excessive yawning has not recurred.
Dr L. is a 46-yr-old physician who began treatment of a major depressive episode with 50 mg}d sertraline. Following 1–2 wk treatment, he began to experience 75–100 yawning episodes daily. This was very distressing to him, as the yawning occurred in the presence of patients, coworkers and during meetings. Frequently, patients made comments regarding the physician’s yawning. This was so bothersome to him that discontinuation of the sertraline was necessary. The excessive yawning remitted within 1 wk and has not recurred following 18 months of treatment with 150 mg}d bupropion SR.
Address for correspondence : Dr M. D. Beale, Institute of Psychiatry (MUSC), 67 President Str. 5 North, PO Box 250861, Charleston, SC, USA.Tel. : 843-792-5700 Fax : 843-792-5702E-mail : bealemd!musc.edu
