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

Letter to the Editor

Sir: Sodium oxybate is increasingly being used off-labelto treat the fibromyalgia syndrome defined by pain, fatigue,nonrefreshing sleep, and fluency loss. This compound has acomplicated mechanism of action with agonist binding on?-aminobutyric acid (GABA)-B receptor, agonist binding on the?-hydroxybutyrate (GHB) receptor, and possible stoichiometricsignaling effects as an intermediary in GABA and glutamatemetabolism. Its clinical effect is a profound increase in the durationof stage III and IV slow wave sleep. This case describesa profound effect of oxybate on bipolar disorder and tardivedyskinesia presenting jointly with fibromyalgia.