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A Case of Sodium Oxybate Treatment of Tardive Dyskinesia and Bipolar Disorder

J Clin Psychiatry 2008;69(5):862 [letter]

Letter to the Editor

Sir: Sodium oxybate is increasingly being used off-label to treat the fibromyalgia syndrome defined by pain, fatigue, nonrefreshing sleep, and fluency loss. This compound has a complicated mechanism of action with agonist binding on ?-aminobutyric acid (GABA)-B receptor, agonist binding on the ?-hydroxybutyrate (GHB) receptor, and possible stoichiometric signaling effects as an intermediary in GABA and glutamate metabolism. Its clinical effect is a profound increase in the duration of stage III and IV slow wave sleep. This case describes a profound effect of oxybate on bipolar disorder and tardive dyskinesia presenting jointly with fibromyalgia.