.png)
Selective serotonin re-uptake inhibitors (SSRI) are one of the most prescribed agents because of their safety and tolerability. The most prominent adverse effects of SSRI are nausea, headache, dizziness, anxiety, changes in sleep and eating patterns, and sexual dysfunction. Nevertheless, extrapyramidal symptoms (EPS) are rarely seen in patients treated with SSRI. Previously, SSRI-induced EPS was reported only in therapeutic doses. In this case report, however, we present an adolescent who attempted to commit suicide with sertraline (700 mg) and developed many EPSs. R.K. was a girl and 16 years of old. She had been started sertraline 50 mg a daily for depressive disorder. At the 20th day of her treatment she attempted to commit suicide-receiving 14 of tablets of 50 mg of sertraline (700 mg). Her parents admitted her to the emergency service. She was not able to walk because of contractions in the foot muscles, had hyperextension of her head because of the contractions in neck muscles. Also, she had oculogyric crisis presenting as fixed eyes upward glance, had tongue swelling and inability to speak, shaking in hands and foots. These symptoms were considered as EPS and biperiden 5 mg/IM was given. After biperiden injection, contractions resolved. Results of all routine hematological and biochemical tests and electrocardiogram were normal. Because of difficulty in speaking, computerized tomography was conducted revealing normal results. She was followed for two days and at the end of the second day, all symptoms had disappeared, thus she was discharged. In this case, EPS was thought to be related to high dose sertraline. SSRI-induced EPS is rare since serotonin also makes dopaminergic re-uptake inhibition. For this reason, there are only limited numbers of SSRI-induced EPS case reports in the literature. A review evaluating the SSRI-related movement disorders between 1977 and 1996 years indicated that 8 out of 71 cases had been associated with sertraline use. In these cases akathisia, contractions in both the neck and in general body parts were reported. One of the mechanisms of sertraline-induced EPS may be the increased amount of serotonin that may inhibit dopaminergic activity through the nigrostriatal dopaminergic pathway. In a recent PET study, extracellular dopamine levels were shown to be decreased after citalopram treatment, which supports this above mentioned theory. This case clearly shows that SSRIs, which are used frequently might cause adverse effects like EPS whether in therapeutic doses or in very high doses.