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Ciguatera Poisoning Presenting as Psychiatric Disorder

K. Michael Lipkin, MD
Arch Gen Psychiatry. 1989;46(4):384-385. doi:10.1001/archpsyc.1989.01810040090018.
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To the Editor.—  A 52-year-old man was referred for psychiatric consultation by his internist because of depression. He appeared anxious and depressed and indicated that he had been experiencing depression, listlessness, fatigue, and general malaise for two to three weeks. He complained of poor sleep, headache, muscular aches, and peculiar sensations in his hands and feet. He believed he was depressed because he was not feeling physically well. He was aware that there had been depression in his family history and that his internist had found no physical cause for his malady.A diagnosis of depressive disorder with somatization was considered, and a trial of pharmacotherapy with ami-triptyline hydrochloride treatment was initiated. Within days, there was a good response to amitriptyline hydrochloride (50 to 75 mg/d). He was sleeping better, the peculiar sensations in his hands and feet decreased, and although he was still feeling weak, his depression was


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