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Comment in:
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.
Publication Types:
PMID: 8909330 [PubMed - indexed for
MEDLINE]
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