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: Bishan Basu, Tanmoy Gangopadhyay, Nivedita Dutta, Bidyut Mandal, Sumitava De, Srikrishna Mondal
• Journal: Current drug safety (Curr Drug Saf) Vol. 9 Issue 1 Pg. 56-9 (Mar 2014) ISSN: 2212-3911 [Electronic] United Arab Emirates
• PMID: 24568368 (Publication Type: Case Reports, Journal Article)

Chemical References

• Adrenergic beta-Antagonists
• Antidepressive Agents, Second-Generation
• Muscle Relaxants, Central
• Serotonin Uptake Inhibitors
• Citalopram
• Clonazepam
• Propranolol

Topics

• Adrenergic beta-Antagonists (therapeutic use)
• Antidepressive Agents, Second-Generation (adverse effects)
• Breast Neoplasms (complications)
• Citalopram (adverse effects)
• Clonazepam (therapeutic use)
• Depressive Disorder (drug therapy, etiology)
• Female
• Humans
• Middle Aged
• Muscle Relaxants, Central (therapeutic use)
• Propranolol (therapeutic use)
• Psychomotor Agitation (drug therapy, physiopathology, therapy)
• Selective Serotonin Reuptake Inhibitors (adverse effects)