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Extrapyramidal side effects and suicidal ideation under fluoxetine treatment a case report.doc

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Extrapyramidal side effects and suicidal ideation under fluoxetine treatment a case report

Christodoulouetal.AnnalsofGeneralPsychiatry2010,9:5 /content/9/1/5 CASE REPORT OpenAccess Extrapyramidalsideeffectsandsuicidalideation underfluoxetinetreatment:acasereport ChristosChristodoulou1*,AthanasiaPapadopoulou1,EmmanouilRizos1,KalliopiTournikioti1,XeniaGonda2, AthanassiosDouzenis1,LefterisLykouras1 Abstract Background:Wepresentthecaseofa52-year-oldwomanwithdepressionwhodevelopedextrapyramidal symptoms(mainlyparkinsonism)andsuicidalideationwhileonfluoxetine. Methods:Thepatientunderwentneurologicalandneuroimagingexamination. Results:Thepatient’sneurologicalandneuroimagingexaminationswerenormalandtherewasnoothercauseof extrapyramidalsymptoms.Thepatientshowedremissionoftheaforementionedsymptomatologywhenfluoxetine wasdiscontinued. Conclusions:Thiscaseshowsthatfluoxetinecanbeassociatedwithextrapyramidalsymptoms,andthismayhave anaggravatingaffectonclinicaldepressionprogressandtheemergenceofsuicidalideation. Background Casepresentation Extrapyramidalsymptoms(EPSs)areanuncommonside A 52-year-old married woman presented to the emer- effectofserotoninreuptakeinhibitors(SSRIs).Concomi- gency department of the Psychiatric Clinic of ‘Attikon’ tantusewithantipsychotic medication orthe presence General Hospital inAthens with depressive symptoms. of other risk factors (age, gender) increase the vulner- Thesymptomshadbegun1monthpriortothereferral ability to EPSs [1]. The most common EPS associated toourhospital, andincluded: depressive mood,insom- with SSRIs seems to be akathisia, followed by dystonia nia,earlymorningwaking,lossofappetiteandpsycho- and parkinsonism. Fluoxetine is the SSRI most asso- motor retardation. At that time she visited a private ciated with extrapyramidal reactions in the majority of psychiatrist, andwasgiven antidepressant therapy with cases[2,3].Even,inadolescentstreatedwithfluoxetine, fluoxetine, 60 mg per day andalprazolam 1.5 mgdaily EPSshavebeenreported[4].Thesymptomsarereversi- for 4 weeks with no significant improv