Influence of paroxetine and cognitive/behavioral strategies in neurocardiogenic syncope and depression: a case report

OBJECTIVE: Neurocardiogenic syncope (NCS) is a condition where the patient has a temporary loss of consciousness or feelings of weakness and fatigue. There are triggers such as prolonged sitting or standing, pain, and heavy exercise, but often episodes are random. Treatments are limited and the use of specific serotonin reuptake inhibitors (SSRI) have had mixed results, but a limited number of studies have suggested that paroxetine may be effective in improving the symptoms of NCS. METHODS: This is a single case report of a 20-year old female who was diagnosed with NCS by a tilt test and treated conservatively with increased fluid and salt intake, and counter-pressure maneuvers. She was given one dose of sertraline, but immediately experienced disturbing visual images. She presented at the Depression Center with moderate depressive symptoms and was started on paroxetine and given cognitive/behavioral strategies to manage the NCS. RESULTS: Since the patient had a negative experience with a prior SSRI, she was started on a low dose of paroxetine and omega-3 fatty acids. She also was given a detailed explanation of NCS and a number of cognitive/behavioral strategies such as deep breathing, progressive relaxation, imagery, and sleep. CONCLUSION: After 2-weeks of the multi-faceted treatment approach, she had a significant decrease in her depressive symptoms. After 6-months, the patient had no episodes of syncope and no depressive symptoms. She was able to stand for long periods and exercise without feelings of weakness and fatigue. A multimodal approach may offer the best treatment strategy to achieve full remission in patients with NCS.