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.