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Escitalopram for antipsychotic nonresponsive visual hallucinosis: eight patients suffering from Charles Bonnet syndrome

  • Yoseph Bergman (a1) and Yoram Barak (a2)


Background: The Charles Bonnet syndrome (CBS) is characterized by distinct visual hallucinations and ocularpathology causing visual impairment in patients with insight and the absence of psychiatric comorbidity. The number of reported cases of CBS is expanding as the population ages and the prevalence of vision disorders increases. Antipsychotic medications are often prescribed. However, their efficacy in CBS has been based on sketchy evidence. The use of serotonin selective reuptake inhibitor (SSRI) for CBS was anecdotally reported. We herein describe effectiveness of escitalopram in a series of patients suffering from CBS who were unresponsive to antipsychotic treatment.

Methods: Eight consecutive patients suffering from CBS who did not respond to standard antipsychotic treatment were switched to escitalopram. CBS severity prior to escitalopram treatment was quantified using the Clinical Global Impression (CGI) scale and again after eight weeks of treatment. All had undergone brain CT and cognitive assessment. Brain CT imaging was normal except for an incidental finding of a small frontal meningioma in one patient. All had Mini-Mental Status Examination scores of ≥ 27/30.

Results: There were four men and four women, with a mean age of 81.7 ± 7.3 years. Previous antipsychotic treatment was mostly with risperidone, 1.0 to 3.0 mg/daily. Mean CGI-severity upon switching to escitalopram treatment was 5.7. This was significantly reduced to 1.8 (p < 0.001) after eight weeks of escitalopram treatment (mean dose: 11.8 mg/daily). There were no side effects, nor any adverse events were reported.

Conclusions: This is the first case-series to show that SSRI is an effective and well-tolerated treatment for visual hallucinations associated with vision impairment such as in CBS.


Corresponding author

Correspondence should be addressed to: Prof. Yoram Barak, MD, MHA, Psychogeriatric Department, Abarbanel Mental Health Center, 15 KKL Street, Bat-Yam 59100, Israel. Phone: +972-3-5552738; Fax: +972-3-5552738. Email:


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Adachi, N., Watanabe, T., Matsuda, H. and Onuma, T. (2000). Hyperperfusion in the lateral temporal cortex, the striatum and the thalamus during complex visual hallucinations: single photon emission computed tomography findings in patients with Charles Bonnet syndrome. Psychiatry and Clinical Neuroscience, 54, 157162.
Barak, Y., Plopski, I., Tadger, S. and Paleacu, D. (2011). Escitalopram versus risperidone for the treatment of behavioral and psychotic symptoms associated with Alzheimer's disease: a randomized double-blind pilot study. International Psychogeriatrics, 15, 15.
Batra, A., Bartels, M. and Wormstall, H. (1997). Therapeutic options in Charles Bonnet syndrome. Acta Psychiatrica Scandinavia, 96, 129133.
Braun, C. M., Dumont, M., Duval, J., Hamel-Hébert, I. and Godbout, L. (2003). Brain modules of hallucination: an analysis of multiple patients with brain lesions. Journal of Psychiatry and Neuroscience, 28, 432449.
Burke, W. J., Roccaforte, W. H. and Wengel, S. P. (1999). Treating visual hallucinations with donepezil. American Journal of Psychiatry, 156, 11171118.
Castro, V. al. (2013). QT interval and antidepressant use: a cross sectional study of electronic health records. BMJ, Jan 29, 346, doi:
Coletti Moja, M., Milano, E., Gasverde, S., Gianelli, M. and Giordana, M. T. (2005). Olanzapine therapy in hallucinatory visions related to Bonnet syndrome. Neurological Science, 26, 168170.
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
Guy, W. (rev. 1976). ECDEU Assessment Manual for Psychopharmacology Biometric Laboratory (US Dept. of Health, Education, and Welfare Publication No. (ADM), 218222;1976). Rockville, MD:
Lang, U. al. (2007). Charles Bonnet Syndrome: successful treatment of visual hallucinations due to vision loss with selective serotonin reuptake inhibitors. Journal Psychopharmacology, 21, 553555.
Maeda, K., Shirayama, Y., Nukina, S., Yoshioka, S. and Kawahara, R. (2003). Charles Bonne! syndrome with visual hallucinations of childhood experience: successful treatment of patient with risperidone. Journal of Clinical Psychiatry, 64, 11311132.
Paulig, M. and Mentrup, H. (2001). Charles Bonnet syndrome: complete remission of complex visual hallucinations treated by gabapentin. Journal of Neurology Neurosurgery and Psychiatry, 70, 813814.
Rovner, B. W. (2006). The Charles Bonnet syndrome: a review of recent research. Current Opinion in Ophthalmology, 17, 275277.
Schadlu, A. P., Schadlu, R. and Shepherd, J. B. 3rd. (2009). Charles Bonnet syndrome: a review. Current Opinion in Ophthalmology, 20, 219222.
Tueth, M. J., Cheong, J. A. and Samander, J. (1995). The Charles Bonnet syndrome: a type of organic visual hallucinosis. Journal of Geriatric Psychiatry and Neurology, 8, 13.


Escitalopram for antipsychotic nonresponsive visual hallucinosis: eight patients suffering from Charles Bonnet syndrome

  • Yoseph Bergman (a1) and Yoram Barak (a2)


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