Extrapyramidal symptoms associated with antidepressants--a review of the literature and an analysis of spontaneous reports.
BACKGROUND
Antidepressant-induced extrapyramidal symptoms (EPS) represent an underrecognized but important clinical entity. We reviewed the literature on new antidepressants and conducted an analysis of cases from the FDA Adverse Event Reporting System (AERS), which has not been published before.


METHODS
A literature review was conducted using PubMed, Ovid, MEDLINE, PsycINFO, and the Cochrane Database. Search terms used were extrapyramidal, antidepressants, selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), serotonin-norepinephrine reuptake inhibitors (SNRIs), norepinephrine-dopamine reuptake inhibitors (NDRIs), miscellaneous antidepressants, and monoamine oxidase inhibitors (MAOIs). Inclusion criteria for the FDA AERS analysis were cases of EPS reported by physicians, cases where patients were on one antidepressant, and cases reported between July 2005 and March 2008. Reports of patients who were on concurrent psychotropics were excluded.


RESULTS
Our literature review revealed 1 report each of EPS for duloxetine, nefazodone, and bupropion, 3 for escitalopram, and 4 for citalopram. For the FDA AERS analysis, 89 cases met our inclusion criteria: duloxetine was implicated in 66% of cases, sertraline in 10%, escitalopram in 7%, and bupropion in 6%.


CONCLUSIONS
EPS have been reported with different classes of antidepressants, are not dose related, and can develop with short-term or long-term use. In view of the risk for significant morbidity and decreased quality of life, clinicians must be aware of the potential for any class of antidepressants to cause these adverse effects.
Madhusoodanan
Subramoniam
S
Department of Psychiatry, St. John's Episcopal Hospital, Far Rockaway, NY 11691, USA. sdanan@ehs.org
Alexeenko
Lada
L
Sanders
Renata
R
Brenner
Ronald
R
D000293:Adolescent; D018759:Adrenergic Uptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems; D000368:Aged; D000369:Aged, 80 and over; D017109:Akathisia, Drug-Induced / Q000175:diagnosis; D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects / Q000627:therapeutic use; D001480:Basal Ganglia Diseases / Q000139:chemically induced* / Q000175:diagnosis; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004409:Dyskinesia, Drug-Induced / Q000175:diagnosis; D004421:Dystonia / Q000139:chemically induced / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008996:Monoamine Oxidase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D014481:United States; D014486:United States Food and Drug Administration; D055815:Young Adult
D018759:Adrenergic Uptake Inhibitors; D000928:Antidepressive Agents; D000929:Antidepressive Agents, Tricyclic; D008996:Monoamine Oxidase Inhibitors; D017367:Selective Serotonin Reuptake Inhibitors