Extrapyramidal reactions following treatment with antidepressants: Results of the AMSP multinational drug surveillance programme

Mörkl, Sabrina; Seltenreich, Daniel; Letmaier, Martin; Bengesser, Susanne; Wurm, Walter; Grohmann, Renate; Bleich, Stefan; Toto, Sermin; Stübner, Susanne; Butler, Mary I.; Kasper, Siegfried

doi:10.1080/15622975.2019.1648871

Cited by 16 publications

(6 citation statements)

References 28 publications

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“…Within this theoretical framework, the variation in affinity for 5-HT 2 receptors between antidepressants may explain the differences in the frequency and the intensity of extrapyramidal symptoms seen in patients. A report using data from a multicenter drug-surveillance program on 15 patients between 1994 and 2016 [27], found that extrapyramidal symptoms frequently occurred with SRIs treatment alone (7/15 cases) or concomitant SRI treatment (6/15 cases) and were most frequent with escitalopram-treatment (5 cases). The authors found that the most common extrapyramidal symptom was atypical dyskinesia (6/15 cases) followed by akathisia (4/15 cases) and extrapyramidal symptoms occurred at any dosage and equally often in men and women.…”

Section: Discussion Of Research Findingsmentioning

confidence: 99%

Antidepressants and movement disorders: a postmarketing study in the world pharmacovigilance database

et al. 2020

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Background: Antidepressants-induced movement disorders are rare and imperfectly known adverse drug reactions. The risk may differ between different antidepressants and antidepressants' classes. The objective of this study was to assess the putative association of each antidepressant and antidepressants' classes with movement disorders. Methods: Using VigiBase®, the WHO Pharmacovigilance database, disproportionality of movement disorders' reporting was assessed among adverse drug reactions related to any antidepressant, from January 1967 to February 2017, through a case/non-case design. The association between nine subtypes of movement disorders (akathisia, bruxism, dystonia, myoclonus, parkinsonism, restless legs syndrome, tardive dyskinesia, tics, tremor) and antidepressants was estimated through the calculation first of crude Reporting Odds Ratio (ROR), then adjusted ROR on four potential confounding factors: age, sex, drugs described as able to induce movement disorders, and drugs used to treat movement disorders.Results: Out of the 14,270,446 reports included in VigiBase®, 1,027,405 (7.2%) contained at least one antidepressant, among whom 29,253 (2.8%) reported movement disorders. The female/male sex ratio was 2.15 and the mean age 50.9 ± 18.0 years. We found a significant increased ROR for antidepressants in general for all subtypes of movement disorders, with the highest association with bruxism (ROR 10.37, 95% CI 9.62-11.17) and the lowest with tics (ROR 1.49, 95% CI 1.38-1.60). When comparing each of the classes of antidepressants with the others, a significant association was observed for all subtypes of movement disorders except restless legs syndrome with serotonin reuptake inhibitors (SRIs) only. Among antidepressants, mirtazapine, vortioxetine, amoxapine, phenelzine, tryptophan and fluvoxamine were associated with the highest level to movement disorders and citalopram, paroxetine, duloxetine and mirtazapine were the most frequently associated with movement disorders. An association was also found with eight other antidepressants.

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Section: Discussion Of Research Findingsmentioning

confidence: 99%

Antidepressants and movement disorders: a postmarketing study in the world pharmacovigilance database

et al. 2020

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“…Most of these cases occurred within 30 days of treatment initiation or dose increase, with citalopram, escitalopram, fluoxetine, and sertraline most frequently involved [90]. This association highlights the importance of monitoring patients during SSRI therapy for the development of EPS [90][91][92].…”

Section: Extrapyramidal Symptomsmentioning

confidence: 93%

“…Although uncommon, EPS in patients treated with SSRIs has been observed in numerous studies [90][91][92]. One study identified 86 case reports connecting the use of SSRIs with the development of dystonia, parkinsonism, dyskinesia, and akathisia.…”

Section: Extrapyramidal Symptomsmentioning

confidence: 99%

Selective Serotonin Reuptake Inhibitors and Adverse Effects: A Narrative Review

Edinoff

Akuly

Hanna

et al. 2021

Neurology International

158

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Depression is the most prevalent psychiatric disorder in the world, affecting 4.4% of the global population. Despite an array of treatment modalities, depressive disorders remain difficult to manage due to many factors. Beginning with the introduction of fluoxetine to the United States in 1988, selective serotonin reuptake inhibitors (SSRIs) quickly became a mainstay of treatment for a variety of psychiatric disorders. The primary mechanism of action of SSRIs is to inhibit presynaptic reuptake of serotonin at the serotonin transporter, subsequently increasing serotonin at the postsynaptic membrane in the serotonergic synapse. The six major SSRIs that are marketed in the USA today, fluoxetine, citalopram, escitalopram, paroxetine, sertraline, and fluvoxamine, are a group of structurally unrelated molecules that share a similar mechanism of action. While their primary mechanism of action is similar, each SSRI has unique pharmacokinetics, pharmacodynamics, and side effect profile. One of the more controversial adverse effects of SSRIs is the black box warning for increased risk of suicidality in children and young adults aged 18–24. There is a lack of understanding of the complexities and interactions between SSRIs in the developing brain of a young person with depression. Adults, who do not have certain risk factors, which could be confounding factors, do not seem to carry this increased risk of suicidality. Ultimately, when prescribing SSRIs to any patient, a risk–benefit analysis must factor in the potential treatment effects, adverse effects, and dangers of the illness to be treated. The aim of this review is to educate clinicians on potential adverse effects of SSRIs.

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“…ЛИД являются довольно редкой НПР при терапии антидепрессантами. Так, по данным австрийского исследования, в котором анализировались экстрапирамидные нарушения на фоне терапии антидепрессантами у пациентов с психическими заболеваниями, за период с 1993 по 2015 г. ЛИД развилась только у трех из 243 588 пациентов [15].…”

Section: антидепрессантыunclassified

“…В доступной литературе имеются в основном описания клинических случаев данной НПР у пациентов с сопутствующими психическими заболеваниями [7]. Чаще всего ОЛИД связаны с применением различных ЛС из группы селективных ингибиторов обратного захвата серотонина [15]. ОЛИД на фоне применения флуоксетина описаны в основном у пациентов, получавших сопутствующую терапию антипсихотиками [16].…”

Section: антидепрессантыunclassified

Drug-induced dystonia

Остроумова

Толмачева

Остроумова

et al. 2020

RJTAO

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Drug-induced dystonia (DID) is a rarely diagnosed adverse reaction to a sufficiently large number of drugs. Acute DID (ADID) occurs soon after starting to take a drug or raising its dose, and switching from one antipsychotic medication to another, especially to its injectable dosage form. Tardive DID (TDID) develops a few months or years after starting drug intake or 3 months after stopping therapy. The diagnosis of TDID is based on the persistence of dystonic hyperkinesis for more than 1 month, the use of a dopamine receptor blocking agent, and the absence of other causes of its development. The risk factors for DID are male sex; young age (less than 30 years of age); a history of dystonic reactions; hypocalcemia, alcohol use while taking the drug. DID is most commonly related to therapy with antipsychotics, metoclopramide, antidepressants, and antiepileptic drugs. The short-term use of anticholinergic drugs (benzotropin, diphenhydramine) is effective in treating ADID. Anticholinergic drugs and atypical antipsychotics (clozapine, quetiapine), benzodiazepines, muscle relaxants (baclofen), and dopamine reuptake inhibitors (tetrabenazine) are used to treat TDID. To prevent DID, it is very important that a physician should be aware of that this unwanted adverse reaction may occur and that a drug with the lowest risk for DID should be chosen.

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Extrapyramidal reactions following treatment with antidepressants: Results of the AMSP multinational drug surveillance programme

Cited by 16 publications

References 28 publications

Antidepressants and movement disorders: a postmarketing study in the world pharmacovigilance database

Antidepressants and movement disorders: a postmarketing study in the world pharmacovigilance database

Selective Serotonin Reuptake Inhibitors and Adverse Effects: A Narrative Review

Drug-induced dystonia

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