Treating Anxiety and Depression in Neuroendocrine tumour

BACKGROUND: Neuroendocrine tumors (NETs) were rare tumors, however due to the wide spread use of endoscopy they are being identified more. Carcinoid syndrome (CS) is the clinical expression for serotonin-producing NETs. Caution is exercised on SSRI use as adverse effects of SSRIs could overlap and exacerbate symptoms of CS. CASE REPORT: A 52 year old lady, with family history of suicide and dementia was referred to Psychiatry for anxiety and sleep disturbances. She was premorbidly well-adjusted and had been having multiple stressors over 2 years. She had 9 months history of dyspeptic symptoms, aches and pains, palpitations, hot flushes, abdominal discomfort, headache, insomnia, anxiety and low mood. She was diagnosed to have Gastric Neuroendocrine tumour Type 1 with DOTATE PET showing the tumour to be dormant, with no other synchronous tumours or metastases. No active intervention was required. The Urine spot 5HIAA was negative. She was referred to psychiatry for the management of anxiety. Her HAM-A score was 39 and BDI score was 26. She was treated with Tab. Propranolol 10 mg BD for 2 weeks after which her HAM- A score reduced to 23 but the depressive symptoms persisted. Tab. Mirtazapine was initiated and after a month she reported normal mood (BDI -3) and no anxiety (HAM – A -1). DISCUSSION: Neuroendocrine Tumor can be functioning or non-functioning tumors. NETs have potential to synthesize multiple metabolically active substances including Serotonin. This case highlights the need for evaluating the functional status of the Neuroendocrine Tumor before treating with SSRIs.