Psychiatric side effects with methysergide - case report

A case report in JNNP describes psychological changes, severe anxiety, and depression in a patient on high-dose methysergide for cluster headache. The report authors suggest that, although the drug remains useful, patients with a predisposition for psychiatric conditions may be "less than ideal candidates" for its use.The 22-year-old patient was taking methysergide for chronic cluster headache, prescribed as an initial dose of 1mg daily and increasing over seven weeks to 12mg daily. The authors report that temporal and spatial perceptual disturbances began to occur after three weeks on the 12mg dose, where objects began to look out of proportion, he experienced deja vu, and had a sense of depersonalisation. He experienced overwhelming insecurity and anxiety and developed symptoms of extreme apathy and despondency. Symptoms settled slowly after methysergide withdrawal, although the family noted that he still experienced uncontrollable feelings of insecurity and anxiety.The authors say, "...there was a close temporal relation between methysergide treatment and syndrome onset, and a partial overall clinical improvement following drug withdrawal," which they say indicates a methysergide-induced reaction.The patient's medical history included childhood counselling and transient psychiatric symptoms while on corticosteroid treatment. Given this history, the authors suggest that an underlying psychiatric predisposition was triggered by methysergide, resulting in the symptoms reported. Based on the observations in this patient and other case reports, the authors suggest that patients who have experienced psychiatric side effects on other treatments or have a predisposition to psychiatric morbidity are not ideal candidates for methysergide treatment.Reference...