Venlafaxine-Induced Acute Dystonia: a Case Report/Venlafaksin kullanimina bagli akut distoni: Olgu sunumu

Headnote

ABSTRACT

Venlafaxine-induced acute dystonia: a case report

Although mechanisms underlying neuroleptic-induced extrapyramidal symptoms have been well researched, extrapyramidal symptoms associated with antidepressants are understudied. Research conducted to date is more concerned with selective serotonin reuptake inhibitors. Recognized risk factors for extrapyramidal symptoms associated with antidepressants are advancing age, female sex, and pharmacokinetic interaction of concurrently used drugs with CYP2D6 inhibition effect. This case is presented to emphasize that the occurrence of extrapyramidal symptoms, which are clinically important side effects requiring intervention, may be related with venlafaxine, a serotonin noradrenaline reuptake inhibitor.

Keywords: Dystonia, extrapyramidal syndrome, venlafaxine

ÖZET

Venlafaksin kullanimina bagli akut distoni: Olgu sunumu

Antipsikotiklere bagli ekstrapiramidal sendromlar iyi arastirilmis olmasina ragmen, antidepresanlara bagli ekstrapiramidal sendromlar yeterince incelenmemistir. Bugüne kadar yapilan arastirmalar daha çok Seçici Serotonin Gerialim Inhibitörleri ile ilgilidir. Antidepresan kullanimina bagli ekstrapiramidal sendrom gelisimi için tanimlanmis risk faktörleri ileri yas, kadin cinsiyet ve es zamanli kullanilan ilaçlarin CYP2D6 inhibisyonu etkilesimidir. Bu olgu klinik olarak son derece önemli ve müdahale gerektiren bir yan etki olan ekstrapiramidal sendromun, venlafaksin gibi bir Serotonin Noradrenalin Gerialim Inhibitörüne bagli olarak da gelisebilecegini vurgulamak amaciyla sunulmustur.

Anahtar kelimeler: Distoni, ekstrapiramidal sendrom, venlafaksin

INTRODUCTION

While antipsychotic-related extrapyramidal syndromes (EPS) have been extensively studied from neuroanatomical, neurophysiological, and neurochemical perspectives, antidepressant-induced EPS have not been researched sufficiently (1). The first report about antidepressant-induced EPS was published in 1959 (2), but by the time that selective serotonin reuptake inhibitors (SSRI) came into wider use in the 1980s, no significant studies were made in the field. In many cases of antidepressant use, extrapyramidal symptoms such as parkinsonism, dystonia, akathisia, and dyskinesia have been reported (3). Studies carried out till now are mainly focused on SSRIs. A number of SSRIs can cause movement disorders; in addition to fluoxetine, this is the case with paroxetine, fluvoxamine, escitalopram, citalopram, and sertraline (1). A study done in the Netherlands between 1985 and 1999, analyzing 24,263 drug side effect reports, found that SSRIs cause EPS more frequently than other antidepressants (4). Based on the number of case reports and the antidopaminergic effect of serotonin on the striatum, we can say that SSRIs constitute EPS more frequently than other antidepressants (5). It has been reported that the incidence of EPS in SSRI use is 1/1,000 or less (6).