title: A case of akathisia induced by escitalopram: case report & review of literature.
abstract: Although cases of Selective Serotonin Reuptake Inhibitor (SSRI) induced akathisia have often been reported in literature, this adverse effect has not adequately been mentioned in major pharmacology textbooks. As a result, SSRIinduced akathisia is very frequently under-recognized. A review of literature showed that almost all frequently used SSRIs such as Fluvoxamine, Fluoxetine, Sertraline, Citalopram have been reported to be causing akathisia. SSRI-induced restless legs syndrome and movement disorders have also been reported. However, Escitalopram-induced akathisia is rare. In our review of literature, we could find only one single case of Escitalopram-induced severe akathisia. And this specific SSRI drug has rarely been implicated with occurrence of restless legs syndrome and extra-pyramidal side-effects like dytonia etc. Here, we present a case of Escitalopram-induced severe akathisia - a 53year old female, who had developed severe akathisia after taking Escitalopram for a few days. According to the Barnes Akathisia Rating Scale (BARS), her Global Clinical Assessment of Akathisia Score was 5 i.e. severe akathisia. As per Naronjo Adverse Drug Reaction Scale the probability of association of this adverse reaction with Escitalopram was 7 (i.e. probable). Her symptoms continued in spite of prompt discontinuation of the drug. But, she improved rapidly with the use of Propranolol and Clonazepam. On the last follow-up, she was free from any symptoms. As new generation antidepressants are rarely associated with extra-pyramidal symptoms, the recognition of such adverse effects requires a high index of suspicion. Early recognition of the symptoms and discontinuation of the offending agent along with supportive therapy like a short course of benzodiazepines, beta-adrenergic antagonists or anticholinergics may rapidly relieve the patient from this distressing symptom.
authors.forename: Bishan
authors.initials: B
authors.lastname: Basu
authors.forename: Tanmoy
authors.initials: T
authors.lastname: Gangopadhyay
authors.forename: Nivedita
authors.initials: N
authors.lastname: Dutta
authors.forename: Bidyut
authors.initials: B
authors.lastname: Mandal
authors.forename: Sumitava
authors.initials: S
authors.lastname: De
authors.affiliation: Department of Radiotherapy, B.S. Medical College, Bankura, West Bengal, India. bishanbasu@gmail.com.
authors.forename: Srikrishna
authors.initials: S
authors.lastname: Mondal
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000150:complications; D015283:Citalopram / Q000009:adverse effects*; D002998:Clonazepam / Q000627:therapeutic use; D003866:Depressive Disorder / Q000188:drug therapy / Q000209:etiology; D005260:Female; D006801:Humans; D008875:Middle Aged; D009125:Muscle Relaxants, Central / Q000627:therapeutic use; D011433:Propranolol / Q000627:therapeutic use; D011595:Psychomotor Agitation / Q000188:drug therapy / Q000503:physiopathology* / Q000628:therapy; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*
chemical_list: D000319:Adrenergic beta-Antagonists; D018687:Antidepressive Agents, Second-Generation; D015283:Citalopram; D002998:Clonazepam; D009125:Muscle Relaxants, Central; D011433:Propranolol; D017367:Selective Serotonin Reuptake Inhibitors