Calcium channel blocker-induced depression: a case report from South India

Flunarizine is a cerebro-selective calcium channel blocker, commonly prescribed for migraine prophylaxis and is considered as non-inferior to propranolol to reduce the frequency of migraine attacks. A 50-year-old female with history of headache for last seven years was using analgesics on and off. As frequency of headache increased, she consulted a doctor one year back and was started on flunarizine 15 mg. She used the medication for eight months without follow-ups and there was modereate improvement. She came to us four months back with complaints of sad mood, decreased sleep, decreased appetite, decreased interest to do work, cring spells, death wishes, and was treated with adequate doses of amitriptyline but had no improvement in symptoms. No medical comorbidities were found. Mental status examination revealed sad mood, anhedonia, negative cognition. After ruling out organic causes and medical work-up, drug-induced depression was considered and flunarizine was stopped, and amitriptyline dose was continued. She reported amelioration in depressive features; follwing which, diagnosis was revised to drug-induced depression.