Extrapyramidal Reactions Associated With Serotonergic Antidepressants

Hawthorne, Jessica M.; Caley, Charles F.

doi:10.1177/1060028015594812

Cited by 60 publications

(43 citation statements)

References 99 publications

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“…Over the years many case reports have associated extrapyramidal symptoms (EPS) with the use of antidepressants. All kinds of EPS are seen in patients taking antidepressants, but akathisia appears to be the most common presentation followed by dystonic reactions, parkinsonian movements and tardive dyskinesia [135]. Akathisia appears to be more common in younger patients as compared with the other EPS symptoms [136].…”

Section: Central Nervous Systemmentioning

confidence: 99%

The Safety, Tolerability and Risks Associated with the Use of Newer Generation Antidepressant Drugs: A Critical Review of the Literature

Carvalho

Sharma²,

Brunoni³

et al. 2016

Psychother Psychosom

508

324

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Newer generation antidepressant drugs (ADs) are widely used as the first line of treatment for major depressive disorders and are considered to be safer than tricyclic agents. In this critical review, we evaluated the literature on adverse events, tolerability and safety of selective serotonin reuptake inhibitors, serotonin noradrenaline reuptake inhibitors, bupropion, mirtazapine, trazodone, agomelatine, vilazodone, levomilnacipran and vortioxetine. Several side effects are transient and may disappear after a few weeks following treatment initiation, but potentially serious adverse events may persist or ensue later. They encompass gastrointestinal symptoms (nausea, diarrhea, gastric bleeding, dyspepsia), hepatotoxicity, weight gain and metabolic abnormalities, cardiovascular disturbances (heart rate, QT interval prolongation, hypertension, orthostatic hypotension), genitourinary symptoms (urinary retention, incontinence), sexual dysfunction, hyponatremia, osteoporosis and risk of fractures, bleeding, central nervous system disturbances (lowering of seizure threshold, extrapyramidal side effects, cognitive disturbances), sweating, sleep disturbances, affective disturbances (apathy, switches, paradoxical effects), ophthalmic manifestations (glaucoma, cataract) and hyperprolactinemia. At times, such adverse events may persist after drug discontinuation, yielding iatrogenic comorbidity. Other areas of concern involve suicidality, safety in overdose, discontinuation syndromes, risks during pregnancy and breast feeding, as well as risk of malignancies. Thus, the rational selection of ADs should consider the potential benefits and risks, likelihood of responsiveness to the treatment option and vulnerability to adverse events. The findings of this review should alert the physician to carefully review the appropriateness of AD prescription on an individual basis and to consider alternative treatments if available.

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Section: Central Nervous Systemmentioning

confidence: 99%

The Safety, Tolerability and Risks Associated with the Use of Newer Generation Antidepressant Drugs: A Critical Review of the Literature

Carvalho

Sharma²,

Brunoni³

et al. 2016

Psychother Psychosom

508

324

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show abstract

“…[2][3][4][5][6][7][8][9][10][11] In a study by Hawthorne et al on cases with EPS related side effects, 80.2% of them were found to have SSRI use. 9 In another study, SSRI, as independent from the use of additional medications, were found to cause 2.2 times as many EPS related side effects regarding the other antidepressants. Paroxetine was also found to be the most related medication to EPS in the category of SSRI (49%) and among all antidepressants (38%).…”

Section: Discussionmentioning

confidence: 99%

“…2,[5][6][7][8][9] Therefore, the purpose of this study is to contribute to the literature on dyskinesia cases by presenting an involuntary choreiform dyskinesia case appearing in the extremities related to the addition of paroxetine on chlorpromazine. To our knowledge, this report is the first case report on the observation of extremity dyskinesia related to paroxetine use.…”

Section: öLmez Et Al 517mentioning

confidence: 99%

“…2 While the EPS related side effects during the period of SSRI treatment have mostly been in the akathisia mode, other movement disorders might also have been observed. [2][3][4][5][6][7][8][9][10][11] It is known that the incidence of EPS in SSRI' use is 1/1000 or less. 3,4 EPS related side effects can both occur with short-term and long-term use of SSRI, and it is not dose related.…”

Section: Introductionmentioning

confidence: 99%

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Paroxetine induced reversible dyskinesia: a case report

Ölmez¹,

Özçetin²,

Ataoğlu³

2017

Anadolu Psikiyatri Derg

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“…Pharmacokinetic interaction at the level of CYP450 metabolism may contribute to raise plasma antipsychotic concentrations. 51 Interestingly, antidepressants have also caused or aggravated restless legs syndrome. Miscellaneous nonneuroleptic drugs have been associated with a low risk of DIP: antiarrhythmics (amiodarone, procaine), acetylcholinesterase inhibitors, antibacterial (rifampicin), antiviral (acyclovir, vidarabine, antiretrovirals), and antifungal (amphotericin B) antibiotics, and hormones (thyroxine).…”

mentioning

confidence: 99%

Drug-induced parkinsonism: diagnosis and management

Blanchet

Kivenko²

2016

JPRLS

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Drug-induced parkinsonism (DIP) has been known for >60 years. It is the second leading cause of parkinsonism, but still underdiagnosis is likely to influence reported incidence figures. Since DIP is clinically undistinguishable from Lewy-body Parkinson’s disease, any new case of parkinsonism should prompt the search for an offending antipsychotic, hidden neuroleptic, or nonneuroleptic agent that may produce DIP. DIP is reversible upon drug withdrawal in most cases. There is no consensus regarding the duration of the recovery period to allow motor signs to fully remit in order to confirm the diagnosis of DIP following removal of the causative agent, but a drug-free interval of at least 6 months is generally recommended. Interestingly, up to 30% of DIP cases may show persisting or worsening motor signs beyond 6 months following drug withdrawal or adjustment, due to complex postsynaptic and presynaptic factors that may variably interact to negatively influence nigrostriatal dopamine transmission in a so-called “double-hit” hypothesis. The condition significantly impacts on quality of life and increases the risks of morbidity and mortality. Management is challenging in psychiatric patients and requires a team approach to achieve the best outcome

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Extrapyramidal Reactions Associated With Serotonergic Antidepressants

Abstract: Case reports associating serotonergic antidepressants with EPRs continue to be published. Practitioners are advised that monitoring for such is important. Rigorous research efforts are needed to better understand the clinical risk factors for these adverse drug reactions.

Cited by 60 publications

References 99 publications

The Safety, Tolerability and Risks Associated with the Use of Newer Generation Antidepressant Drugs: A Critical Review of the Literature

The Safety, Tolerability and Risks Associated with the Use of Newer Generation Antidepressant Drugs: A Critical Review of the Literature

Paroxetine induced reversible dyskinesia: a case report

Drug-induced parkinsonism: diagnosis and management

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