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Celexa and Lexapro vs. Regular SSRI's

A Continuing Education Lecture for Doctors

In my research I have found that anti-depressants are not all the same and some have problems rarely mentioned to you.

All major anti-depressants have muscle disorders and movement disorders. Citalopram or escitalopram (Lexapro) seems to have this problem less then others.

In looking at the 11 million references in Pubmed we find 127 published reports of SSRI-induced movement disorders of Zoloft, Paxil and Prozac.

When did you hear about these types of side effects at your last meeting with a physician who prescribed these medications?

In addition to my concern that doctors have too little time to discuss side effects, if we only look at only Canadian manufacturing reporting, we have almost a thousand cases.

Samples from just manufacturers of only one country, Canada, listed from SSRI unpublished reports:

Akathisia - 49 cases
Dystonia - 44 cases
Dyskinesia - 208 casew
Tardive Dyskinesia - 76 cases
Parkinsonism - 516 cases
Bruxism - 60 cases

(Annals of Pharmacotherapy 1998;32:692)

The point: this issue of various anti-depressant SSRI-induced movement disorders is not incidental.

SSRI's Also Seem to Increase Akathisia

Akathisia Definition: Akathisia is a subjective inner agitation and dysphoria.

Not always with motor restlessness.

Patients struggle to define it.

My impression is that SSRI-induced akathisia is incorrectly perceived, and diagnosed as:

*Anxiety disorders
*Onset side effects of the medication
*New stressors
*Panic disorder
*Anxiety from Major Depression
*Anesthesia effects

If a person is slowed down from Parkinson's Disease the akathisia will not be observable

(Akathasia masked by hypokinesia. Pharmacopsychiatry 2000;33:147-9)

Does severe depression, which can slow down a person, hide akathisia? Perhaps, so if you are slowed down, look at your inner feelings and tell the doctor if you feel restless.

Does Age Effect Movement Problems
from SSRI's?

Yes, according to a good study.

Adverse reactions of SSRI's from a Swedish spontaneous reporting system - approximately 1200 reports reviewed.

*Parkinsonism, hallucinations, hyponatremia
more often reported in elderly

*Akathisia more often reported in the relative
"younger" patients

*Akathisia, dyskinesia and aggression more
common in men

(J of Psychopharmacology 1998;12:192)

Anti-Depressants have different movement disorder frequencies.

One example:

Remission of SSRI-induced akathisia after switch to nefazodone (Serzone). (J of Clinical Psychiatry 2001;62:570)

The Complexities of Akathisia

Akathisia increases depression

Akathisia hinders attention

Akathisia causes cognitive problems.

(Subjective emotional experience and cognitive impairment in drug-induced akathisia. Comprehensive Psychiatry 2002;43:456-62 & The symptomology of akathisia. Fortschr Neurol Psychiatr 1997;65:232-6)

I have looked at the data pulled from 11 million medical references and have found the following examples of movement disorders associated with each common anti-depressant.

You should appreciate there are side effects of not treating a depression and side effects of using an anti-depressant.

PAROXETINE (PAXIL)

Paroxetine and akathisia (Biological Psychiatry 1995;37:336)

A case of paroxetine-induced akathisia (Biological Psychiatry 1996:39:910)

Three cases of akathisia were found in 67 patients treated with paroxetine at Mass. General. (Akathisia: a review and case report following paroxetine treatment. Comprehensive Psychiatry 1996:37:122-4). 1/22 patients.

Paroxetine and tardive akathisia (Canadian J Psychiatry 2000;45:398)

Paroxetine and tardive dyskinesia (J Clinical Psychopharmacology 1996;16:258-9)

A case of paroxetine-induced dyskinetic movements (J Clinical Psychopharmacol 2000;20:712-3)

Parkinsonism exacerbated by paroxetine. (Neurology 1994;44:2406)

Tourette's syndrome and antidepressant therapy: exacerbation of nervous tics with paroxetine (Z Kinder Jugendpsychiatr Psychther 2000;28:105-8)

SERTRALINE (ZOLOFT)

Summary article reports EPS with fluoxetine, paroxetine and mention 14 published cases of sertraline induced EPS. (Progress Neuropsychopharmacol Biol Psychiatry 1998;5:741)

Sertraline and extrapyramidal side effects (American J Psychiatry 1994;151:288)

Sertraline-induced akathisia and dystonia misinterpreted as a panic attack (Psychiatric Services 2002;53:1477)

Sertraline and akathisia: spontaneous resolution (Biological Psychiatry 1997;41:241)

Sertraline and akathisia (J Clinical Psychopharmacology 1994;14:278)

Sertraline and akathisia (American J Psychiatry 1994;151:620)

Akathisia and sertraline (J Clinical Psychiatry 1993;54:321)

Sertraline-induced akathisia (J Clinical Psychopharmacology 1993;13: 219)

Case report of probable sertraline-induced akathisia (American J Psychiatry 1993;150:986)

Five patients aged 40-85 had EPS which remitted when sertraline removed. (Ned Tijdschr Geneeskd 1996;140:1467 Dutch)

Sertraline has been ... associated with Parkinsonis. Usually appears in first few days and leaves as fast. Case of woman who took months to have symptoms go and then onset of true Parkinson's 14 months later (J. Clin Therapy 2001;26:111)

FLUVOXAMINE (LUVOX)

Extrapyramidal symptoms in a patient treated with fluvoxamine (J Neurol Neurosurg Psychiatry 1992;55:330)

Case report of mandibular dystonia (Canadian J Psychiatry 1995;40:430)

Dyskinesia associated with fluvoxamine (J Clinical Psychopharmacology 1993;13:365)

Fluvoxamine and akathisia (J Clinical Psychopharmacology 1996;16:334)

FLUOXETINE (PROZAC)

Fluoxetine and extrapyramidal side effects (American J. Psychiatry 1996;153:449).

Fluoxetine and extrapyramidal side effects (American J. Psychiatry 1989;146:1352).

Persistent dyskinesia in a patient receiving fluoxetine (American J Psychiatry 1991;148:1403).

Fluoxetine induced dyskinesia case with rapid onset and cessation after stopping fluoxetine (Aust N Z J Psychiatry 1994;28:328).

Fluoxetine associated dystonia (American J Psychiatry 1994;151:149).

Acute dystonia and fluoxetine (J. Clinical Psychiatry 1992;53:327).

Fluoxetine-related indifference and akathisia. A case report (Therapie 1993;48:158).

Discusses 71 cases of SSRI induced EPS. 75% from fluoxetine (J Clinical Psychiatry 1996;57:449).

Akathisia 45%
Dystonia 28%
Parkinsonism 14%
TD-like state 11%

72-year-old woman with rhythmic palatal movements, chorea and possibly dystonia while on fluoxetine which stopped when drug stopped after 5 days. 56-year-old male with rapid stereotypic toe movements on drug (Movement Disorders 1996;11:324).

Acute Dystonia caused by fluoxetine (Medical Clinics Barc 1992:99:436)

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