Extrapyramidal symptoms associated with antidepressants--a review of the literature and an analysis of spontaneous reports.

Aug 4, 2010Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists

Movement Side Effects Linked to Antidepressants: Review and Report Analysis

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Abstract

Among 89 reported cases of antidepressant-induced extrapyramidal symptoms (EPS), duloxetine was implicated in 66% of cases.

EPS have been documented with various classes of antidepressants, indicating a broader risk than previously recognized.
The occurrence of EPS is not linked to dosage levels, suggesting that even lower doses may pose a risk.
EPS may arise with both short-term and long-term use of antidepressants, highlighting the need for ongoing monitoring.
The analysis included cases reported between July 2005 and March 2008, focusing on patients taking single antidepressants.

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BACKGROUND: Antidepressant-induced extrapyramidal symptoms (EPS) represent an underrecognized but important clinical entity. We reviewed the literature on new antidepressants and conducted an analysis of cases from the FDA Adverse Event Reporting System (AERS), which has not been published before.

METHODS: A literature review was conducted using PubMed, Ovid, MEDLINE, PsycINFO, and the Cochrane Database. Search terms used were extrapyramidal, antidepressants, selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), serotonin-norepinephrine reuptake inhibitors (SNRIs), norepinephrine-dopamine reuptake inhibitors (NDRIs), miscellaneous antidepressants, and monoamine oxidase inhibitors (MAOIs). Inclusion criteria for the FDA AERS analysis were cases of EPS reported by physicians, cases where patients were on one antidepressant, and cases reported between July 2005 and March 2008. Reports of patients who were on concurrent psychotropics were excluded.

RESULTS: Our literature review revealed 1 report each of EPS for duloxetine, nefazodone, and bupropion, 3 for escitalopram, and 4 for citalopram. For the FDA AERS analysis, 89 cases met our inclusion criteria: duloxetine was implicated in 66% of cases, sertraline in 10%, escitalopram in 7%, and bupropion in 6%.

CONCLUSIONS: EPS have been reported with different classes of antidepressants, are not dose related, and can develop with short-term or long-term use. In view of the risk for significant morbidity and decreased quality of life, clinicians must be aware of the potential for any class of antidepressants to cause these adverse effects.

Extrapyramidal symptoms associated with antidepressants--a review of the literature and an analysis of spontaneous reports.

Abstract

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