title: Escitalopram-induced Parkinsonism.
abstract: OBJECTIVE
  Since the early reports associating extrapyramidal side effects (EPS) to serotonin reuptake inhibitors (SSRI), SSRIs have been pointed as more common offenders among antidepressants in producing EPS. The induction of EPS by SSRIs has been thought to be a consequence of serotonergically mediated inhibition of the dopaminergic system. We would like to present a case of escitalopram-induced Parkinsonism to increase awareness of this clinical problem.
  
  
  METHODS
  A 29-year-old male patient complaining of anger outbursts was started on escitalopram 10 mg/day without titration for impulse control in an outpatient clinic. Personal and family history was not significant for any chronic disorder, including movement disorders.
  
  
  RESULTS
  Two weeks after the initiation of escitalopram, the patient started complaining of tremor, rigidity, slowness of movement, use of small steps when walking difficulty to rise when seated, disturbance of speech and along with the development of a mask-like facial expression. An MRI of the brain revealed normal findings. With a diagnosis of drug-induced Parkinsonism, he was started on 4-mg/day biperiden leading to full resolution of symptoms in 4 weeks, with no further complaints at follow up for 1.5 years.
  
  
  CONCLUSIONS
  As described, drug-induced Parkinsonism may persist or remit slowly despite prompt discontinuation of the offending drug. Some patients may require medications temporarily to relieve symptoms.
authors.affiliation: Aksaray State Hospital, Psychiatry Clinic, Aksaray, 68100 Turkey. Electronic address: sertac@hacettepe.edu.tr.
authors.forename: Sertaç
authors.initials: S
authors.lastname: Ak
authors.affiliation: Hacettepe University Faculty of Medicine, Department of Psychiatry, Ankara, Turkey.
authors.forename: A Elif
authors.initials: AE
authors.lastname: Anıl Yağcıoğlu
mesh_terms: D000328:Adult; D000978:Antiparkinson Agents / Q000627:therapeutic use; D001712:Biperiden / Q000627:therapeutic use; D015283:Citalopram / Q000009:adverse effects*; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000188:drug therapy*; D006801:Humans; D008297:Male; D020734:Parkinsonian Disorders / Q000139:chemically induced* / Q000188:drug therapy; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*
chemical_list: D000978:Antiparkinson Agents; D001712:Biperiden; D015283:Citalopram; D017367:Selective Serotonin Reuptake Inhibitors
keywords: Biperiden; Escitalopram; Extrapyramidal side effects; Parkinsonism