A 62-year-old woman was initially presented as an outpatient ten years ago to the Department of Psychiatry at the University Hospital of Occupational and Environmental Health in Japan. She presented with mild mood swings, impulsive aggression, and reduced motivation and volition caused by a traumatic brain injury after a traffic accident. She had no previous history of substance abuse, hypertension, diabetes mellitus, or thyroid dysfunction. Magnetic resonance imaging revealed small hyperintensities in the left temporal and anterior frontal lobes, hippocampus, and amygdala. Based on the Wechsler Adult Intelligence Scale-Third Edition, the verbal intelligence quotient (IQ), performance IQ, and full IQ were 91, 96, and 92, respectively, which indicated normal intelligence. Her Mini-Mental State Examination score was 30/30, which indicated no cognitive impairment. She was often emotionally unstable; further, she was occasionally aggressive and cried after quarreling with her family members.
We initiated carbamazepine (CBZ) at an initial dose of 200 mg/day, which was increased to 600 mg/day. After four weeks, her mood swings gradually improved. She remained stable taking CBZ; however, she continued to present reduced motivation and volition. When the COVID-19 outbreak occurred in Japan, social media became inundated with COVID-19-related content. Consequently, she became concerned about COVID-19 and complained of multiple episodes of severe anxiety and shortness of breath that involved excessive sweating, body trembling, mouth dryness, and fear of death in public spaces. As a result, she could not go to the supermarket by herself due to excessive fear of contracting the illness. Further, her depressive mood worsened. Based on these symptoms, she was diagnosed with panic disorder comorbid with organic mood disorder and was prescribed sertraline (25 mg/day, which was increased to 100 mg/day) and 0.4 mg alprazolam as required. Her panic symptoms did not improve; consequently, vortioxetine was started and increased to 20 mg/day, while sertraline was tapered off. Four weeks after initiating vortioxetine, her symptoms of panic disorder and depressive mood, and reduced motivation were ameliorated. Further, her plasma level of CBZ was 6.4 mug/ml. Although the COVID-19 pandemic continues in Japan, she has remained well without any panic attacks while continuing vortioxetine treatment. The patient has been in remission of all mood symptoms and panic attacks. Written informed consent was obtained from the patient for publication of the present case report.