Posted by ed_uk on December 3, 2004, at 7:47:07
In reply to EPS from SSRI or other Antidepressants?, posted by Mr.Scott on December 2, 2004, at 23:52:38
Hi! Here are some reports of EPS with SSRIs..............
Fluoxetine-induced akathisia: clinical and theoretical implications.
Lipinski JF Jr, Mallya G, Zimmerman P, Pope HG Jr.
Laboratory for Psychiatric Research, McLean Hospital, Belmont, Mass 02178.
Five patients receiving fluoxetine (Prozac) for the treatment of obsessive compulsive disorder or major depression developed akathisia. The typical fluoxetine-induced symptoms of restlessness, constant pacing, purposeless movements of the feet and legs, and marked anxiety were indistinguishable from those of neuroleptic-induced akathisia. Three patients who had experienced neuroleptic-induced akathisia in the past reported that the symptoms of fluoxetine-induced akathisia were identical, although somewhat milder. Akathisia appeared to be a common side effect of fluoxetine and generally responded well to treatment with the beta-adrenergic antagonist propranolol, dose reduction, or both. The authors suggest that fluoxetine-induced akathisia may be caused by serotonergically mediated inhibition of dopaminergic neurotransmission and that the pathophysiology of fluoxetine-induced akathisia and tricyclic antidepressant-induced "jitteriness" may be identical.
Acute dystonic reaction in an elderly patient with mood disorder after titration of paroxetine: possible mechanisms and implications for clinical care.
Arnone D, Hansen L, Kerr JS.
Department of Psychiatry, Old Manor Hospital, Salisbury, UK. Danilo.Arnone@wshsc.nhs.uk
The administration of a serotonin reuptake inhibitor may lead to extra pyramidal signs, as reported in the literature. The risk seems to be increased in elderly people. We describe a case of acute dystonic reaction to paroxetine (Paxil/Seroxat) treatment in an elderly patient, who presented with a bipolar affective disorder. The underlying mechanism, possibly generated in the subcortical motor areas, is linked to changes that occur in the pharmacokinetic variables, the decreased neuroplasticity of ageing neurones and to previous exposure to neuroleptic medications.
Sertraline induced parkinsonism. A case report and an in-vivo study of the effect of sertraline on dopamine metabolism.Di Rocco A, Brannan T, Prikhojan A, Yahr MD.
The Mount Sinai Medical Center, Department of Neurology, New York, NY, USA.
We report a patient with a parkinsonian syndrome induced by sertraline (Zoloft), an SSRI antidepressant, whose symptoms resolved after the drug was discontinued. This case prompted us to investigate the effect of sertraline on dopamine metabolism in animals. Sertraline (30 mg/kg, i.p.) or placebo (vehicle) was administered to two groups of six normal, anesthetized rats and using cerebral microdyalisis extracellular striatal levels of dopamine, the dopamine metabolites (HVA and DOPAC), as well as the serotonin metabolite 5-HIIA were monitored. In animals pre-treated with sertraline, DOPAC, HVA, and 5-HIAA levels were significantly decreased compared to control animals (p < 0.01). These data indicate that sertraline has an effect on dopamine metabolism, which may alter function in the striatum and induce a parkinsonian syndrome.
Tardive dyskinesia associated with fluoxetine.
Dubovsky SL, Thomas M.
Department of Psychiatry, University of Colorado School of Medicine in Denver, USA.
Three cases in which patients who were taking fluoxetine for relief of depression showed patterns of abnormal movements suggestive of tardive dyskinesia are presented. In the first case, abnormal facial movements began four weeks after fluoxetine was added to doxepin and lithium and remitted after fluoxetine was discontinued. In the second case, abnormal movements of the mouth and hands were noticed four years after the patient started taking fluoxetine and continued to be present a year after withdrawal of the medication. In the third case, orofacial dyskinesia that had remitted after withdrawal of sertraline and paroxetine and reappeared with fluoxetine was still present eight months after fluoxetine was withdrawn.
poster:ed_uk
thread:423636
URL: http://www.dr-bob.org/babble/20041201/msgs/423803.html