Selective serotonin reuptake inhibitors (SSRIs) have been increasingly used in the treatment of children and adolescents. Extrapyramidal symptoms (EPSs) are an uncommon side effect of serotonin reuptake inhibitors (SSRIs). The most common EPS associated with SSRIs seems to be akathisia, followed by dystonia and Parkinsonism. Fluoxetine is the SSRI, most associated with extrapyramidal reactions in the majority of cases. We present two cases that developed extrapyramidal symptoms (mainly dystonia) on şuoxetine.
Case 1. A 10-year-old girl was admitted to our polyclinic with complaints including unhappiness, anhedonia and academic failure. Psychotic disorder and depression diagnosis were in family history. Fluoxetine 10 mg/day liquid dose was initiated and 10 days later increased to 20 mg/day dose. Patient was admitted to the emergency with limb spasm,backache and rash, which were resolved with intramuscular administration of biperidene.
Case 2. A 11-year-old girl was admitted to hospital with throbbing headache ten months ago. EEG findings and MR venogram were normal. Plaques were established in cranial MRI. Valproate treatment was initiated. Drug wasn’t used regularly. A year later patient was admitted to neurology clinic with headache, drop and swoon. Topiramate and methylprednisolone treatments were initiated because of plaques. 3 weeks later headache was continued. Fluoxetine liquid 10 mg/day was initiated for anxiety. Muscle spasm, joint pain and akathisia were presented after 5 days. Complaints were resolved with intramuscular injection of 5 mg biperidene.
The exact frequency of occurrence of EPS with antidepressants is unclear, but the estimated incidence is 1 per 1000 or less among SSRI users. Any EPS can interfere with patient compliance, causing significant morbidity and, ultimately, decreased quality of life. Clinicians should be aware of the potential for any class of antidepressants to cause EPS.