Neuroleptic malignant syndrome under treatment with antidepressants? A critical review.
Neuroleptic malignant syndrome (NMS) is a rare complication of treatment with neuroleptics. The pathophysiology is not fully known. A dopaminergic transmission block in the basal ganglia and hypothalamus is thought to be the pathophysiological mechanism of NMS. Several cases of NMS have been reported, precipitated by medication without a direct effect on the dopaminergic system. This Medline analysis concerns 23 cases of antidepressant-induced NMS reported in the literature with the differing pathophysiological hypotheses on the precipitation of NMS. The results indicate no hard evidence of an antidepressant-evoked NMS. However, various hypotheses assuming an disturbed balance of the dopaminergic and non-dopaminergic system may be relevant in animal studies, but are without clinically relevant proof presently. An antidepressant-induced NMS is a very rare complication on the basis of pretreatment with neuroleptics causing chronic dopamine blockade and elevated plasma level of neuroleptics due to comedicated antidepressants.
Assion
H J
HJ
Department of Psychiatry, University of Bochum, Germany.
Heinemann
F
F
Laux
G
G
D000928:Antidepressive Agents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D009459:Neuroleptic Malignant Syndrome / Q000209:etiology* / Q000503:physiopathology
D000928:Antidepressive Agents