The Link Between Amitriptyline and Movement Disorders: Clinical Profile and Outcome

Abstract

Introduction: Amitriptyline (AMT) is a tricyclic antidepressant. In this review, we evaluate the clinical and epidemiological profile, pathological mechanisms and management of AMT-associated movement disorders. Materials and Methods: A search for relevant reports in 6 databases was performed. Studies that reported patients developed only ataxia or tremor after AMT use were excluded. Results: A total of 48 reports on 200 cases were found. AMT-associated movement disorders included myoclonus (n = 26), dyskinesia (n = 11), dystonia (n = 8), stutter (n = 5), akathisia (n = 3) and restless legs syndrome (n = 1). For less well-defined cases, 99 patients had dyskinesia, 19 had psychomotor disturbances, 3 had myoclonus, 11 had dystonia, 12 had Parkinsonism and 1 each had akathisia and extrapyramidal symptoms. Mean and standard deviation (SD) and median ages were 45.40 years (SD 16.78) and 40 years (range 3.7–82 years), respectively. Over half were women (58.13%) and the most common indication was depression. Mean and median AMT doses were 126 mg (SD 128.76) and 75 mg (range 15–800 mg), respectively. In 68% of patients, onset of movement disorders was <1 month; time from AMT withdrawal to complete recovery was <1 month in 70% of cases. A weak negative linear correlation (r = −0.0904) was found between onset of movement disorders and AMT dose. AMT withdrawal was the most common treatment. Conclusion: Amitriptyline is associated with various movement disorders, particularly myoclonus, dystonia and dyskinesias. Stutters and restless legs syndrome are some of the less common associations. Ann Acad Med Singapore 2020;49:236–51 Key words: Akathisia, Drug-induced, Dyskinesia, Dystonia, Myoclonus

Gabapentin-Associated Movement Disorders: A Literature Review

“…Chau et al reported a patient with Creutzfeldt–Jakob disease-like syndrome induced by gabapentin toxicity, in which electrodiagnostic studies showed periodic sharp wave complexes [ 40 ]. A similar clinical manifestation with electrodiagnostic studies was already observed with amitriptyline [ 121 ] and fluoroquinolones [ 17 ].…”

Phenytoin-associated movement disorder

“…The time from PHT start to DTN onset was the lowest among PHT-associated MDs. This is a characteristic feature of drug-induced DTN and was reported with antiepileptic drugs and tricyclic antidepressants[ 66 ]. An interesting fact is that DTN only occurred with the highest doses of PHT, which is a distinctive finding compared to the published literature.…”

Frequency, risk factors, and impacts on quality of life of the restless legs syndrome and side effects among antidepressant users in a tertiary hospital: an observational cross-sectional study

“…Thus, as expected, different antidepressant groups, which increase serotonergic neurotransmission, could also induce RLS. Regarding this hypothesis, besides SSRI/SNRIs, atypical antidepressant mirtazapine, tricyclic antidepressants, and other antidepressant groups could provoke RLS to different degrees (Rissardo and Caprara, 2020a, 2020b). But we did not find any statistically significant differences between SSRIs and SNRIs in terms of RLS (Table 4).…”