Hippocampal agenesis in an individual who engaged in violent criminal behaviors after discontinuing carbamazepine and paroxetine treatment

J Forensic Sci. 2013 Jan;58(1):255-8. doi: 10.1111/j.1556-4029.2012.02248.x. Epub 2012 Aug 24.


Antidepressant discontinuation syndrome (ADS) occurs after abrupt discontinuation of an antidepressant medication. A 23-year-old man with right hippocampal agenesis demonstrated sexual crime (hypersexuality) since the age of eight and had been successfully treated with carbamazepine since the age of 13. He had required increased doses of paroxetine and carbamazepine owing to the development of an unstable affect after quitting his job. He abruptly stopped taking his medication for 3 days and his criminal behaviors re-emerged. We examined changes in brain structure and activity before and after medication cessation, using MRI and functional MRI (fMRI). The image of a girl in a swimsuit increased activity in the thalamus only after medication discontinuation. The alteration in thalamic activity might induce hypersexuality. We conclude that a primary hypersexuality had been suppressed with carbamazepine and paroxetine treatment, and the discontinuation of the medication caused the hypersexuality.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Antidepressive Agents, Second-Generation / therapeutic use
  • Antimanic Agents / therapeutic use
  • Brain Mapping
  • Carbamazepine / therapeutic use
  • Crime
  • Disruptive, Impulse Control, and Conduct Disorders / drug therapy
  • Disruptive, Impulse Control, and Conduct Disorders / psychology*
  • Forensic Psychiatry
  • Hippocampus / abnormalities*
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Medication Adherence
  • Paroxetine / therapeutic use
  • Sexual Behavior / drug effects
  • Sexual Behavior / psychology*
  • Substance Withdrawal Syndrome / psychology*
  • Thalamus / physiology
  • Young Adult


  • Antidepressive Agents, Second-Generation
  • Antimanic Agents
  • Carbamazepine
  • Paroxetine