mise à jour du
11 mars 2007
J Clin Psychopharmacol
Duloxetine-induced excessive
disturbing and disabling yawning
De Las Cuevas C, Sanz EJ.
Psychiatry & clinical pahrmacology. School of medicine
University La Laguna, NCanary Islands. Spain


Duloxetine is a selective serotonin and norepinephrine reuptake inhibitor recently introduced into clinical psychiatric practice. Although yawning was frequently observed during the premarketing and postmarketing clinical trials of duloxetine, no cases of severe disabling yawning have been reported until now. Excessive yawning has been observed for other antidepressant drugs including clomipramine, fluoxetine, citalopram, sertraline, and paroxetine. To our knowledge, this is the first report of duloxetine-induced disturbing and disabling yawning.
The patient was a Spanish man approximately 50 years of age who began treatment of an anxiety disorder with 60-mg duloxetine, taken orally at breakfast. Cognitive behavioral therapy was also prescribed. Three days after drug treatment was initiated, the patient began to yawn excessively during the day, despite adequate sleep at night. The excessive yawning was not accompanied by drowsiness, yet he was unable to intentionally stop himself from yawning. This secondary effect was described by the patient as being uncomfortable and disabling in his job as a teacher because the yawning persisted while lecturing to his pupils. The frequency of yawning was greater in the morning than in the afternoon. His anxiety symptoms disappeared after 4 weeks, but the treatment was continued for 4 months with excessive daytime yawning still occurring. His excessive yawning was completely resolved when drug treatment ended at week 18.
The patient was a 32-year-old Spanish woman with symptoms consistent with a moderate depressive disorder. Treatment included cognitive behavioral therapy in combination with 60-mg duloxetine, taken orally at the main meal. The patient reported excessive daytime yawning after 1 week of treatment, yet treatment was continued because the patient was on sick leave. At 6 weeks, the patient's mood improved, allowing her to return to the workplace. Three days later, the patient noticed that the yawning was disturbing and found the drug treatment very disabling in her job as a driver. She experienced yawning while sitting in traffic jams, when driving with negligible traffic, and when driving at night. The excessive yawning was not accompanied by drowsiness and disappeared completely once treatment with duloxetine was terminated.
Yawning is a common physiological event that occurs infrequently in humans and animals and is usually, but not exclusively, triggered by fatigue or boredom. It is characterized by gaping accompanied by a long inspiration, followed by a shorter expiration. Yawning resembles classical reflexes because once initiated, the specific pattern of motor output associated with inspiration/ expiration is completed with minimal influence by sensory feedback. Currently, the physiological function of yawning and the neurochemical mechanism by which it occurs are not completely understood. Research indicates that yawning is controlled by several neurotransmitters and neuropeptides including dopamine, excitatory amino acids, acetylcholine, serotonin, nitric oxide, adrenocorticotropic hormone-related peptides, and oxytocin. gamma-aminobutyric acid, noradrenaline, and neurotensin also influence yawning. Occasionally, these chemicals interact in the paraventricular nucleus of the hypothalamus to facilitate or inhibit the expression of this behavioral response. Based on this information, it is possible that the inhibition of reuptake of neuronal serotonin, norepinephtine, and dopamine by duloxetine may be responsible for the excessive yawning described here. However, yawning usually does not represent a secondary effect that necessitates the termination of treatment, but in the 2 cases reported here, its frequency and intensity were disabling. Therefore, clinicians should be aware that duloxetine may evoke excessive daytime yawning that could be disabling for some patients.
Philibert C, Sauveplane K, Pinzani-Harter V et al. Le bâillement: de la physiologie à la iatrogénie. La lettre du pneumologue. 2011;14(5):168-172
Bâillements et dépression - Yawning and depression
Le bâillement: de la physiologie à la iatrogénie
Yawning: from physiology to iatrogenic effect yawning-iatrogene