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Background
Citalopram is a widely prescribed selective serotonin reuptake inhibitor (SSRI) for the treatment of depression and anxiety disorders, among others. Movement disorders, such as akathisia, parkinsonism and tardive dyskinesia, are known side effects of citalopram, 1 presumably caused by a serotonergically mediated inhibition of the dopaminergic system. 2 However, isolated involuntary movements of the tongue as a side effect have not been reported. Involuntary muscle jerks of the tongue are a rare finding that can easily be confused with fasciculations, an ominous symptom of motor neuron disease.
Case presentation
A 51-year-old man was referred to our outpatient department with troublesome involuntary movements of the tongue. Ten days before he woke up with mumbling speech and noticed continuous movements of the tongue. Swallowing and general muscle strength were not affected. The patient also reported worsening of a long-standing tremor of his hands. This tremor was present for many years and was somewhat relieved by consuming alcohol. Other symptoms were a general feeling of restlessness and inability to sit still since 2 weeks.
Two weeks before the onset of symptoms he started taking citalopram 10 mg daily, which was prescribed to him by his primary care physician because of stress and anxiety due to problems related with his business. Concomitant he used methylphenidate 10 mg each day for an attention deficit hyperactive disorder and acetylsalicylic acid 80 mg daily for secondary prophylaxis after a transient ischemic attack. Despite a positive family history for cardiovascular diseases, the patient has been smoking for 30 years. His father was diagnosed with Parkinson's disease at the age of 50.
Inspection of the tongue showed continuous, irregular, small jerks of the tongue muscle, without the involvement of the palatum. He was unable to keep his tongue still and the amplitude of the movements increased with tongue protrusion ( video 1 ). His...