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Introduction: Carisoprodol is a centrally acting muscle relaxant used in the treatment of various musculoskeletal disorders whose main metabolite, meprobamate, is a controlled substance in the United States due to its sedative properties and potential for abuse., Case Description: We report a case of a 51-year-old man with cognitive impairment and tremor who developed worsening tremor, anxiety, myoclonus, ataxia, and psychosis on abrupt cessation of carisoprodol. At hospital discharge, his cognitive function significantly improved compared with when he was on carisoprodol., Conclusion: Carisoprodol withdrawal is an important and under-recognized syndrome that should be considered in patients presenting with neurologic symptoms who are taking the medication. Carisoprodol withdrawal can be successfully treated with the use of benzodiazepines, although further studies are needed to identify the most appropriate treatment protocol.

The authors identified patients with the coexistence of narcolepsy and another CNS disorder seen between 1975 and 1998 at their institution. Eighteen patients were identified, nine with narcolepsy commencing within 1 year before or after the other disorder. Seven patients (39%) had hypothalamic-pituitary syndromes. When they occur together, narcolepsy and other CNS disorders frequently emerge at about the same time, suggesting a causative relationship. Hypothalamic-pituitary pathology was the most common association.

Little is known about the safety of electroconvulsive therapy (ECT) following any surgical procedure. We present two cases of elderly patients who required treatment with ECT shortly after eye surgery. One patient received ECT 12 days post cataract surgery. The other patient received ECT 1 week post vitrectomy on one eye, and then a few years after that she received ECT 2.5 weeks post cataract surgery on the other eye. There were no complications or adverse events for either patient. We review the existing literature on the effects of ECT on intraocular pressure and discuss the implications on patients who have recently undergone ophthalmic surgery.

Although several studies have investigated the impact of various antidepressant medications on melatonin, there are no published reports addressing the effects of electroconvulsive therapy (ECT). Melatonin's major urinary metabolite, 6-sulfatoxymelatonin (6MT), was measured before and after an acute course of ECT. Fourteen subjects diagnosed with major depression who had failed prior pharmacologic therapy were enrolled. 6MT excretion was measured using an enzyme-linked immunosorbent assay test in 24 hour samples separated into daytime and nighttime components. Hamilton Rating Scale for Depression scores showed a significant improvement (p < 0.0001). Data analysis using the Wilcoxon signed rank test demonstrated a significant decrease in 24 hour 6MT post-ECT (p < 0.016) and daytime 6MT (p < 0.008). These results demonstrate an association between a therapeutic response to ECT and decrease in endogenous melatonin production.

Sleep disturbances are a frequent complication of depressive disorders and their treatment. Familiarity with the interaction among sleep, depression, and antidepressant medications may assist the clinician in selecting agents to suit the needs of individual patients. The authors review the current knowledge of changes in sleep architecture associated with particular antidepressant agents and with depressive illness, as well as the theoretical relevance of such changes to the antidepressant effect. Articles for review were found through a Medline search on the terms "polysomnography," "sleep," "antidepressants," and "insomnia" in English-language papers published from 1966 through March 2000. Additional articles were found in the reference lists of relevant papers.