Excessive Yawning During Escitalopram Therapy in a Rwandan Woman with Co-Morbid Depression and Post-Traumatic Stress Disorder: A Case Report

Abstract: Excessive yawning is an uncommon but recognized adverse effect of selective serotonin reuptake inhibitors (SSRIs). Although generally benign, it may cause distress and may be mistaken for a symptom of psychiatric or neurological illness. Case reports and pharmacovigilance data have linked escitalopram to yawning, sometimes in a dose-dependent manner. To our knowledge, this is one of the first reported cases of escitalopram-associated yawning in Rwanda. We describe a 44-year-old woman from rural Rwanda who presented with a severe depressive episode and comorbid post-traumatic stress disorder (PTSD). Three days after starting escitalopram 10 mg daily, she reported markedly increased yawning, approximately six episodes every 15 minutes throughout the day, while her sleep and mood had begun to improve slightly. Medical and neurological causes, sleep-related causes and concurrent short-term diazepam use were considered and judged unlikely. The Naranjo Adverse Drug Reaction Probability Scale score was 5, indicating a probable adverse drug reaction. Escitalopram was continued because of emerging antidepressant benefit, and the yawning had decreased substantially at the two-week follow-up. This case suggests that yawning occurring early in escitalopram treatment should be recognized as a probable adverse drug reaction. Awareness of this under-reported effect may prevent unnecessary investigations and premature discontinuation of an effective antidepressant. Keywords: escitalopram, selective serotonin reuptake inhibitor, excessive yawning, adverse drug reaction, PTSD, depression, Rwanda