Amitriptyline, a tricyclic antidepressant has been used in the treatment not only for major depression but also chronic pain. The present case report suggests that amitriptyline has possibility to induce auditory hallucination even in conventional dose throughout the treatment of chronic pain including AO.Īuditory hallucination is generally associated with psychotic disease such as schizophrenia, and depression, dementia, and other organic brain lesions moreover, sometimes it is induced by antidepressants ( 1– 4). Two months after the discontinuation, auditory hallucination was almost disappeared with no recurrence of AO. After final prosthodontic treatment, the amitriptyline was discontinued in 30 months.
Magnetic resonance imaging and psychiatric consultation revealed no abnormality of brain and in psychiatric aspects.
Amitriptyline was decreased and continued with the dose of 25 mg. The adverse event of amitriptyline was suspected since she had never had psychotic symptoms before. At the time she reported auditory hallucination, she worried whether organic brain diseases are hiding because the frequency of voices was increased and sometimes occurred in daytime. She had not realized that the voices were auditory hallucination since they were heard only at midnight infrequent and not bothering her daily life. The voices were neighborhoods' and talking about the noise troubles she had claimed before. In 24 months, the AO symptoms were very much improved however, she reported that she had been heard the voices at midnight for a year. Therefore, the dose of amitriptyline was decreased, and the continuation dose was set 30 mg. Although the temporary recurrence was observed following to the retreatment of prosthodontic dental procedures, it improved in a few weeks. Amitriptyline was initially prescribed 25 mg and gradually increased up to 60 mg with the improvement of AO symptoms in 7 months. A 43-years-old female, housewife, complained chronic toothache following dental procedures and was diagnosed as AO. This is a first case report about the AO patients who showed auditory hallucination by the low dose of amitriptyline. Anticholinergic adverse events induced by amitriptyline are usually bearable and not critical since the prescription dose is very low for the patients with AO. Amitriptyline is considered as one of the first line medications for the psychopharmacotherapy of chronic pain including atypical odontalgia (AO) which shows chronic tooth pain without corresponding abnormalities. It was rarely found as adverse events of antidepressants. 3Department of Basic Dental Sciences, Faculty of Odonto-Stomatology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VietnamĪuditory hallucination is usually associated with psychiatric diseases and organic brain illness.2Department of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.1Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.Motoko Watanabe 1 *, Tetsuo Nakabayashi 2, Gayatri Nayanar 1, Chihiro Takao 1, Chizuko Maeda 1, Trang Thi Huyen Tu 1,3, Haruhiko Motomura 1 and Akira Toyofuku 1
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