Escitalopram-induced Parkinsonism

Objective: Since the early reports associating extrapyramidal side effects (EPS) to serotonin reuptake inhibitors (SSRI), SSRIs have been pointed as more common offenders among antidepressants in producing EPS. The induction of EPS by SSRIs has been thought to be a consequence of serotonergically mediated inhibition of the dopaminergic system. We would like to present a case of escitalopram-induced Parkinsonism to increase awareness of this clinical problem. Method: A 29-year-old male patient complaining of anger outbursts was started on escitalopram 10 mg/day without titration for impulse control in an outpatient clinic. Personal and family history was not significant for any chronic disorder, including movement disorders. Results: Two weeks after the initiation of escitalopram, the patient started complaining of tremor, rigidity, slowness ofmovement, use ofsmall stepswhenwalking difficulty to risewhen seated, disturbance of speech and along with the development of a mask-like facial expression. AnMRI of the brain revealed normal findings. With a diagnosis of drug-induced Parkinsonism, he was started on 4-mg/day biperiden leading to full resolution of symptoms in 4 weeks, with no further complaints at follow up for 1.5 years. Conclusion: As described, drug-induced Parkinsonism may persist or remit slowly despite prompt discontinuation of the offending drug. Some patientsmay require medications temporarily to relieve symptoms. (C) 2014 Elsevier Inc. All rights reserved.