Volume 166 - Issue 5
Movement disorders with selective serotonin reuptake inhibitors
Med J Aust 1997; 166 (5): 259.
Published online: 3 March 1997
Published online: 3 March 1997
Movement disorders with selective serotonin reuptake inhibitors
Adverse Drug Reactions Advisory Committee
MJA 1997; 166: 259
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Orolingual dyskinesia - Cases - Akathisia - Case - Comment - References
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| The selective serotonin reuptake inhibitors (SSRIs) are being prescribed increasingly for major depression. The Adverse Drug Reactions Advisory Committee (ADRAC) has received more than 1800 postmarketing reports of adverse reactions to the SSRIs (fluoxetine, paroxetine and sertraline), with the most common reactions reported being rashes, headache, anorexia, nausea, vomiting, diarrhoea, dizziness, agitation, tremor and increased sweating. Reports describing the movement disorders of orolingual dyskinesia and akathisia are reviewed here. | |
Orolingual dyskinesia |
Marchioni et al. described orolingual movements (intermittent
facial movements, initially involving the tongue and lips) in a
74-year-old woman who had taken fluoxetine for seven months. 1 ADRAC has received nine reports of orolingual dyskinesia (after excluding reports describing tardive dyskinesia or orolingual movements as part of a generalised dyskinesia) where an SSRI was the only suspected drug since 18 January 1993. Fluoxetine was the suspected drug in four reports, sertraline in three and paroxetine in two. The nine reports described seven women and two men aged 22-89 years (median, 51 years). These dyskinesias were variously described as abnormal involuntary orolingual-buccal movements, persistent repetitive jaw movements, involuntary chewing movements and involuntary facial movements. In eight of the nine patients, they started within one month of starting to take the SSRI; in the remaining patient the movements started five months after starting to take the SSRI. Six of the nine patients had recovered at the time of reporting. |
Cases |
A 29-year-old woman taking no other medications was prescribed
paroxetine 20 mg daily for depression. Four hours after taking only
one paroxetine tablet she developed persistent repetitive jaw
movements with chattering of her teeth. The movements and chattering
occurred markedly for two days, and continued to occur with cold or
fatigue over the next two weeks before gradually settling. She took no
tablets after the first one.
In another case, a 22-year-old man taking no other medications was prescribed a 20 mg paroxetine tablet daily for depression. After taking paroxetine for four weeks he experienced involuntary facial movements, accompanied by disturbed speech and agitation. He immediately stopped taking the paroxetine and quickly and fully recovered. |
Akathisia |
Olivera described a 40-year-old woman who developed akathisia (a
form of restlessness in which there is the inability to sit still, an
urge to move about constantly and a feeling of muscular quivering)
after three days of taking paroxetine 20 mg daily. 2 ADRAC has received nine reports of akathisia where an SSRI was the only suspected drug since 17 February 1993. Fluoxetine was the suspected drug in six reports, paroxetine in two and sertraline in one. These nine reports described seven women and two men aged 29-86 years (median, 54 years). The akathisia started within 33 days of commencing the SSRI in seven patients, and the onset was within two days of commencing the SSRI in two of these seven. However, in the remaining two patients, the akathisia started five and eight months after commencing the SSRI. Eight of the nine patients had recovered at the time of reporting. |
Case | An 86-year-old woman was prescribed 20 mg paroxetine daily for depression. Her only other medication was 5 mg felodipine daily, which she had started taking 12 months previously. She developed akathisia after taking paroxetine for five months -- she was unable to keep still, with restless legs and a constant need to pace. After she stopped taking the paroxetine only, she recovered fully. |
Comment |
Although acute dystonia is well recognised as an early adverse
reaction to SSRIs, orolingual dyskinesia might be mistakenly
thought to only occur later as tardive dyskinesia. It is important for
prescribers to be aware that movement disorders such as orolingual
dyskinesia and akathisia can occur in patients of any age, and that
their onset may vary considerably from immediately on starting
treatment to after many months of treatment.
Adverse Drug Reactions Advisory Committee,
|
References |
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