Frågedatum: 1996-12-15
RELIS database 1996; id.nr. 13810, DRUGLINE
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Do irreversible side-effects like tardive dyskinesia occur during treatment with SSRI:s or clomipra



Fråga: Do irreversible side-effects like tardive dyskinesia occur during treatment with SSRI:s or clomipramine?

Sammanfattning: Several cases where tardive dyskinesia has been an alleged result from treatment with tricyclic antidepressants or SSRI´s have been found. Most of these reports include concomitant treatment with neuroleptics. However, there are single cases in which a SSRI has been judged a possible or probable cause of the condition.

Svar: A similar question has recently been answered by the Drug Information Centre (1). In general, tricyclic antidepressants and SSRI´s can potentially induce extrapyramidal side-effects including akatisia, dystonia, dyskinesia and other parkinsonian symptoms. The document gives no information about tardive dyskinesia. Instead concomitant treatment with neuroleptics is said to contribute to extrapyramidal symptoms in many cases.

The files of the Swedish Adverse Drug Reactions Advisory Committee (SADRAC) contain five cases of tardive dyskinesia related to treatment with antidepressant drugs. Among these there are two cases that refer to treatment with paroxetine and one case of clomipramine treatment. In two of the five cases the drug has been judged a possible or probable cause of tardive dyskinesia. In total 40 cases of extrapyramidal side-effects, (tardive dyskinesia excluded) were found among all SSRI:s.

The WHO register contains in total 15 cases of treatment with sertraline, 28 cases of paroxetine, 69 cases of fluoxetine, three cases of fluvoxamine and five cases of clomipramine where tardive dyskinesia has been reported during treatment with these drugs. No case of tardive dyskinesia and treatment with citalopram was found. Other antidepressants that have been associated with tardive dyskinesia were: 18 cases of amitriptyline, seven cases of imipramine, three cases of nortriptyline, one case of each for maprotiline, trimipramine and moclobemide, two cases of mianserin, and 11 cases of venlafaxin. The figures given from the WHO database refer to reports that have not been evaluated by the WHO Centre.

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