Improvement of Neuropsychiatric Lupus with Addition of SSRI Antidepressant/Antipsychotic Therapy.

Neuropsychiatric lupus erythematosus (NPLE) is a major cause of morbidity and mortality. We report a case involving an adolescent female who developed acute NPLE, manifesting as acute delusional depression with suicidal ideation. Despite high-dose corticosteroid therapy, these symptoms persisted. Within 7 to 10 days of initiation of paroxetine, a selective serotonin reuptake inhibitor (SSRI) and fluphenazine, an antipsychotic agent, the patient's neurovegetative symptoms of depression improved and suicidality remitted. Psychosis resolved with longer treatment. Undoubtedly these drugs were treating a psychiatric complication of the underlying disease. Our case supports the notion that some severe neuropsychiatric symptoms can be reversed without reliance upon immunosuppressants. It is premature to advocate unconditional acceptance of this approach, vet the findings in our case suggest that early adjunctive treatment with paroxetine and fluphenazine for steroid-resistant NPLE might spare a subset of patients the toxic effects and complications of immunosuppressants. This is the first report to describe a novel adjunctive treatment with the SSRI antidepressant, paroxetine. Our findings merit further investigation with larger numbers of patients.