Depression and dysphoria in adult and adolescent patients with Tourette's disorder treated with risperidone.
BACKGROUND
Depression is a common comorbid condition in patients with Tourette's disorder. While risperidone is not usually known to induce dysphoria or depression in patients treated for other psychiatric disorders, previous short-term 4- to 12-week trials of risperidone for Tourette's disorder have reported a 2.6% to 30.8% incidence of depression.


METHODS
A retrospective study was carried out in 58 adult and adolescent patients with Tourette's disorder (Tourette Syndrome Classification Study Group diagnosis) who received risperidone between Jan. 1, 1993, and Dec. 31, 2000, at the Allan Memorial Institute, McGill University Health Centre, Montreal, Quebec, Canada. Charts of all patients were examined for evidence of, and risk factors for, DSM-IV-defined major depressive disorder (MDD) or dysphoria.


RESULTS
Seventeen (29.3%) of 58 patients developed MDD, including 1 patient who later committed suicide and 13 patients (22.4%) who became dysphoric while taking risperidone. Nine of the 17 patients who developed MDD were relapses, i.e., patients with a history of depression prior to taking risperidone, while the remainder were new cases, i.e., patients with no previous history of depression. A positive personal history of MDD was the only factor to significantly (p <.001) predict the development of depression while taking risperidone. Seventy percent of those who developed MDD or dysphoria and discontinued risperidone did so specifically as a result of this adverse event.


CONCLUSIONS
MDD and dysphoria commonly occurred in this cohort of adult and adolescent Tourette's disorder patients treated with risperidone, particularly in patients with a previous history of depression. Depression and dysphoria were frequent reasons for risperidone discontinuation.
Margolese
Howard C
HC
Clinical Psychopharmacology Unit, Allan Memorial Institute, McGill University Health Centre, and the Department of Psychiatry, McGill University, Montreal, Quebec, Canada. meggem@po-box.mcgill.ca
Annable
Lawrence
L
Dion
Yves
Y
D000293:Adolescent; D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003863:Depression / Q000139:chemically induced* / Q000175:diagnosis / Q000523:psychology; D003865:Major Depressive Disorder / Q000139:chemically induced* / Q000175:diagnosis / Q000523:psychology; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011358:Product Surveillance, Postmarketing; D011792:Quebec; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D018967:Risperidone / Q000009:adverse effects* / Q000627:therapeutic use; D005879:Tourette Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology
D014150:Antipsychotic Agents; D018967:Risperidone