A case of akathisia induced by escitalopram: case report & review of literature

• Published in: Current drug safety Vol. 9; no. 1; p. 56
• Main Authors: Basu, Bishan, Gangopadhyay, Tanmoy, Dutta, Nivedita, Mandal, Bidyut, De, Sumitava, Mondal, Srikrishna
• Format: Journal Article
• Language: English
• Published: United Arab Emirates 01.03.2014
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Antidepressive Agents, Second-Generation - adverse effects; Breast Neoplasms - complications; Citalopram - adverse effects; Clonazepam - therapeutic use; Depressive Disorder - drug therapy; Depressive Disorder - etiology; Female; Humans; Middle Aged; Muscle Relaxants, Central - therapeutic use; Propranolol - therapeutic use; Psychomotor Agitation - drug therapy; Psychomotor Agitation - physiopathology; Psychomotor Agitation - therapy; Serotonin Uptake Inhibitors - adverse effects
• ISSN: 2212-3911
• DOI: 10.2174/157488630901140224104651

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.