Dystonic Rabbit Syndrome From Citalopram

Abstract

Citalopram can rapidly induce dystonic rabbit syndrome. This effect suggests that for some patients citalopram has neuropsychiatric effects similar to those of a dopamine-blocking antipsychotic drug. This might be of concern with patients who cannot communicate well (eg, young children; patients with dementia, developmental disabilities, or aphasia).

Newer antipsychotics and the rabbit syndrome

“…Interestingly, neuroleptic exposure was found to be unrelated to following six documented cases of RS [11,16-18,20]. Truong [16] described a case of RS observed in a 76-year-old female who had undergone brain surgery 16 years earlier.…”

“…Phenol intoxication may have caused RS by inducing cholinergic dominance in the central nervous system. RS was also observed in patients treated with imipramine, citalopram, paroxetine and methylphenidate [11,18-20]. It is possible that these antidepressants, potent inhibitors of serotonin reuptake, caused RS through a serotonin-mediated inhibition of dopaminergic neurotrasmission in the basal ganglia in predisposed subjects [21,22].…”

Sentinel node navigation surgery versus observation as a management strategy for early tongue carcinoma

“…A 2.5 Hz tardive jaw tremor has been reported in one case 25. Both a 5 to 6 Hz jaw tremor26 and a case of typical rabbit syndrome27 have been reported with citalopram therapy. Jaw tremor has also been reported with amiodarone toxicity28 and phenytoin toxicity 46…”

Escitalopram-Induced Progressive Cervical Dystonia

“…11 Recently, escitalopram has also been implicated in other extrapyramidal symptoms and movement disorders including akathisia, 16 myoclonus, 17 and parkinsonism. 18 The close relative of escitalopram, citalopram, which includes the pharmacologically inactive R-citalopram in addition to the active S-citalopram, has also been reported to cause bruxism, 19 rabbit syndrome, 3 and reemergence of antipsychotic-induced dyskinesia, 20 as well as dystonia. 9 None of the previously reported dystonic reactions have had similar characteristics of a dosedependent progressive nature as seen in Mr. R.…”

“…Some of the well-known side effects include gastrointestinal distress, sweating or flushing, and sexual dysfunction. SSRIs have also been infrequently associated with several movement disorders, including akathisia, 1 parkinsonism, 2 rabbit syndrome, 3 tardive dyskinesia, 4 other dyskinesias, 5 and dystonic reactions. [6][7][8][9][10][11][12] Dystonic reactions are painful, usually acute, involuntary contractions of muscle groups that have been commonly reported with antipsychotics but occur much more rarely with SSRIs.…”