title: Extrapyramidal Reactions Associated with Serotonergic Antidepressants.
abstract: OBJECTIVE
  Extrapyramidal reactions (EPRs) associated with serotonergic antidepressant treatments have been reported since 1958. These reactions can be distressing for patients and complicate treatment. Our objective was to complete a follow-up review of published EPR cases reported for serotonergic antidepressants.
  
  
  METHODS
  Published cases between January 1998 and May 2015 were collected through a medical literature search. Citation reference lists were also searched manually.
  
  
  METHODS
  Identified cases were reviewed for patient age, gender, psychiatric diagnosis, dosage, time to reaction onset, concurrent medications, and EPR description. Cases were excluded when there was not a clear description, if descriptions were not consistent with accepted deﬁnitions, or if the written English was poor. We included cases of akathisia, dystonia, dyskinesia, parkinsonism, or mixed EPRs. Authors scored each case using the Naranjo adverse drug reaction probability scale.
  
  
  RESULTS
  We identified 86 published reports involving 91 patients; selective serotonin reuptake inhibitors were implicated in 80.2% of cases. All EPR types were reported: 17 akathisia cases, 18 dyskinesia cases, 27 dystonia cases, 19 parkinsonism cases, and 10 mixed EPR cases. EPRs typically occurred within 30 days of either treatment initiation or dose increase. Age, gender, antidepressant dosing, or concurrent antipsychotic treatment did not appear to broadly contribute to EPR risk. Naranjo scores ranged from 2 to 8.
  
  
  CONCLUSIONS
  Case reports associating serotonergic antidepressants with EPRs continue to be published. Practitioners are advised that monitoring for such is important. Rigorous research efforts are needed to better understand the clinical risk factors for these adverse drug reactions.
authors.affiliation: Providence VA Medical Center, Providence, RI, USA.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Hawthorne
authors.affiliation: University of Connecticut, Storrs, CT, USA c.caley@uconn.edu.
authors.forename: Charles F
authors.initials: CF
authors.lastname: Caley
mesh_terms: D018759:Adrenergic Uptake Inhibitors / Q000009:adverse effects; D000367:Age Factors; D017109:Akathisia, Drug-Induced / Q000209:etiology / Q000503:physiopathology; D000928:Antidepressive Agents / Q000009:adverse effects*; D014150:Antipsychotic Agents / Q000009:adverse effects; D004409:Dyskinesia, Drug-Induced / Q000209:etiology / Q000503:physiopathology; D005116:Extrapyramidal Tracts / Q000187:drug effects* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D010302:Parkinson Disease, Secondary / Q000209:etiology / Q000503:physiopathology; D011595:Psychomotor Agitation / Q000188:drug therapy; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*; D012737:Sex Factors
chemical_list: D018759:Adrenergic Uptake Inhibitors; D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D017367:Selective Serotonin Reuptake Inhibitors
keywords: akathisia; antidepressive agents; dyskinesia; dystonia; humans; parkinsonism; serotonin reuptake inhibitors