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Comment in:
·
J Clin Psychiatry. 1997
Sep;58(9):403-4.
·
J Clin Psychiatry. 1998 Mar;59(3):133.
Movement
disorders associated with the serotonin selective reuptake inhibitors.
Leo RJ.
Department of Psychiatry, School of Medicine, State University of New York at
Buffalo 14215, USA.
BACKGROUND: To review the case reports and case series of movement disorders
ascribed to the use of serotonin selective reuptake inhibitors (SSRIs). METHOD:
Reports of SSRI-induced extrapyramidal symptoms (EPS) in the literature were
located using a MEDLINE search and review of bibliographies. RESULTS: Among the
71 cases of SSRI-induced EPS reported in the literature, the most common side
effect was akathisia (45.1%), followed by dystonia (28.2%), parkinsonism
(14.1%), and tardive dyskinesia-like states (11.3%). Among patients with
Parkinson's disease treated with SSRIs, there were 16 cases of worsening
parkinsonism. Patients who developed dystonia, parkinsonism, or tardive
dyskinesia were older on average than patients with akathisia; 67.6% of
affected patients were females. Fluoxetine, the most commonly prescribed SSRI
to date, was implicated in 53 (74.6%) of cases of SSRI-induced EPS. Several
reports (57.7%) were confounded by the concomitant use of other medications
that can contribute to the development of EPS. CONCLUSION: SSRI-induced EPS are
probably related to agonism of serotonergic input to dopaminergic pathways
within the CNS. Several patient-dependent and pharmacokinetic variables may
determine the likelihood that EPS will emerge. Although these side effects are
infrequent, clinicians should be alert to the possibility of their occurrence.
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