Page 74 - JCBP-2-1

Journal of Clinical and
Basic Psychosomatics Elevated serum amylase in MDD patient

Table 2. Medication for 2 days after admission catatonic stupor have demonstrated significantly increased
salivary amylase level , similar to the patient’s condition
[17]
Medications Day 1 Day 2 in this case. After admission to the hospital, the patient
Evening Morning Noon Evening remained in a state of sub-stupor and tension until the
Cefprozil (g) 0.25 - - - 3 day, when the elevation of amylase was detected. Even
rd
Ceftazidime (g) - 2 - - on the 5 day, despite being able to walk in the ward
th
Ambroxol (mg) 30 30 30 - with the support of family, the patient displayed extreme
Paroxetine (mg) - 10 - - tension and resistance when visiting the doctor’s office,
Olanzapine (mg) 2.5 - - - accompanied by muscle stiffness that causes slipping off
the chair. Therefore, it is plausible that the patient’s salivary
Lorazepam (mg) 0.5 - 0.5 - amylase was at a high level during that time, potentially
Silybin meglumine 200 200 200 - resulting in elevated serum amylase level . It has been
[18]
tablets (mg) proposed that salivary-type amylase is the predominant
Zopiclone (mg) 3.75 - - - fraction of serum amylase and is derived from salivary
Compound paracetamol - - - 1 tablet gland tissue and other organs .
[2]
tablet (paracetamol
500 mg and caffeine 4. Conclusion
65 mg)/1 tablet
In summary, the patient’s high tension and sub-stupor
reported to have pancreas-protective properties and state due to depression may contribute to the secretion of
can reduce amylase level . In this case, the patient had salivary amylase in the serum, leading to elevated serum
[10]
only taken a small amount of paroxetine. In addition, amylase level.
an animal experiment even showed that paroxetine While elevated serum amylase is commonly associated
can lower serum amylase level . Therefore, it is highly with pancreatitis and other serious physical diseases, it
[11]
unlikely that paroxetine contributed to the increase in is essential to consider psychiatric factors as well. In this
amylase level in this patient. Among all the medications, case, we observed a potential link between the patient’s
the most likely candidate to cause the elevation of serum psychiatric symptoms and the elevation of serum amylase.
amylase is olanzapine. The previous studies and reports Serum amylase could serve as an important blood
have indicated that a rare adverse reaction of olanzapine biochemical marker indicative of the severity of depression.
is acute pancreatitis, which typically occurs approximately Based on this case, we speculate that in addition to physical
12 weeks after administration. CT scans have revealed acute illness, the stupor symptoms experienced by patients with
edematous pancreatitis, acute hemorrhagic pancreatitis, depression may also lead to elevated serum amylase level.
and acute necrotizing pancreatitis in patients receiving Therefore, when encountering such situations clinically, it is
olanzapine . Therefore, the influence of olanzapine crucial for clinicians to prioritize addressing psychological
[12]
cannot be completely ruled out in the present case. symptoms.
This case report aims to explore additional possibilities
and provide clinicians with further considerations and Acknowledgments
insights. We would like to express our sincere gratitude to the
For this case, determining the exact cause of the increased Department of Geriatric Psychiatry, the Affiliated
serum amylase level is challenging, and it cannot be solely Brain Hospital of Nanjing Medical University, for their
attributed to olanzapine. Several other possibilities exist, assistance in treating the patient. We are also thankful to
such as psychiatric symptoms contributing to the elevation the patient for his sacrifice and dedication to medicine
in serum amylase level. Prior reports have associated and research.
elevated serum amylase with psychiatric symptoms. First,
depression patients have inherently higher salivary amylase Funding
level compared to healthy individuals [13,14] , suggesting that The study was supported by the National Natural Science
the baseline serum amylase level in a depressed patient Foundation of China (81871066); Jiangsu Provincial
might be higher. Second, the patient’s nervousness and key research and development program (BE2018609,
sub-stupor state after admission might further increase BE2019675); Jiangsu Provincial Medical Innovation
salivary amylase level, as salivary amylase is a marker of Team of the Project of Invigorating Health Care through
sympathetic nerve activity and tends to rise significantly Science, Technology and Education (CXTDC2016004);
[15]
under psychological pressure . Cases of schizophrenia in Key Project supported by Medical Science and Technology
[16]
Volume 2 Issue 1 (2024) 4 https://doi.org/10.36922/jcbp.0550