Major depression with musical obsession treated with vortioxetine: a case report

Transcranial magnetic stimulation as a novel approach to effectively treat musical obsession (stuck song syndrome): a case series and a systematic review of case reports

This is the first case series that demonstrates the use of transcranial magnetic stimulation (TMS) for the treatment of musical obsessions or stuck song syndrome (SSS), following a systematic review that identified existing treatments. SSS can occur independently, but in literature it is commonly reported as an obsessive-compulsive disorder (OCD) or major depressive disorder (MDD) symptom. Most people are familiar with earworms, experienced by up to 98% of the western population. Earworms can become severe leading to the SSS diagnosis. SSS is a distressing repetition of involuntary tunes persisting in one's mind. According to literature, SSS has often been treated using antidepressants which are used to treat MDD and OCD. As TMS has shown a positive therapeutic effect for psychiatric disorders particularly MDD and OCD, we hypothesized that TMS could be an effective treatment that reduces symptoms of patients with SSS. We present two cases of TMS treatment contributing to a reduction in symptoms of SSS. We also aim to provide a systematic review of cases where SSS has been described and compare the pharmacological or psychotherapeutic treatments used with our novel TMS interventions for SSS. This report highlights some limitations, including patient's psychiatric comorbidities and treatment protocol changes, which affect the findings generalizability. Despite these limitations, TMS appears promising as a treatment for SSS due to the observed effectiveness in reducing SSS symptoms and minimal side effects especially in medication-resistant cases.

Vortioxetine as an alternative treatment for somatic symptom disorder: case report

Somatic symptom disorder (SSD) is characterized by persistent physical symptoms that cause significant distress and functional impairment. Despite the widespread use of serotonin reuptake inhibitors (SRIs) in treating SSD, some patients experience insufficient response, necessitating alternative therapeutic approaches. We report two cases of SSD that demonstrated significant improvement with vortioxetine, a novel antidepressant with multimodal serotonergic receptor activity. In Case 1, an 88-year-old female with throat discomfort and cough experienced an insufficient response to an SRI. After switching to vortioxetine, she achieved significant symptom relief within 10 days, with no relapse observed over the following four months. In Case 2, a 29-year-old female presenting with widespread somatic pain and palpitations, unresponsive to analgesics, achieved symptom resolution within two weeks with the initial use of vortioxetine. The therapeutic effects of vortioxetine were rapid and well-tolerated. These cases highlight the potential of vortioxetine for treating SSD, particularly in cases of insufficient response to SRIs, and suggest a possible overlap between SSD and obsessive-compulsive spectrum disorders through its action on serotonergic pathways.

Testing the Two-Factor Model of Musical Obsessions: Can They Be Predicted by the Interaction Between Frequency and Dysfunctional Interpretations of Common Earworms?

Musical obsessions can be conceptualized as a severe form of intrusive musical imagery (IMI). The two-factor model of musical obsessions proposes that musical obsessions result from the interaction of the frequency of IMI and dysfunctional interpretations of IMI. The aim of this study was to evaluate the predictions of the two-factor model. A total of 372 participants (291 without a known diagnosis of obsessive–compulsive disorder [OCD] and 81 with a lifetime diagnosis of OCD) completed online questionnaires about the frequency of IMI, their dysfunctional interpretations, and their severity. We specified a model with severity of IMI as outcome and interpretations and frequency as predictors and controlled for the type of sample. The interaction between frequency and dysfunctional interpretations predicted severity of IMI, however in another direction than suggested. Future studies should include experimental and longitudinal designs and pay particular attention to low-frequency IMI and their role in musical obsessions.