Extrapyramidové příznaky při terapii SSRI

Extrapyramidal Symptoms duringSSRI Therapy

With the expanding prescription of antidepressants from the group of selective inhibitors ofserotonin uptake (SSRI) physicians are faced with some less frequent but serious undesirableeffects. The latter include also extrapyramidal motor disorders (EPS). They are anticipated andrecognized in classical neuroleptics, during SSRI therapy their occurrence is surprising, sometimes also due to the prolonged interval between the first administration of the preparation andthe onset of EPS symptoms. The frequency of EPS and proportion of different types of disordersdiffers after different preparations.In the submitted paper the authors summarize available findings on the incidence, assumedmechanism of development and treatment of EPS in SSRI. From a review of the literature ensuesthat acute disorders predominate over tardive ones. In the total number of published disordersacathizia (45 %) is most frequent, followed by dystonia (28 %) and parkinsonian rigidity (14 %).Less frequent are tardive dyskinesia (11 %) and parkinsonian tremor (10 %). The theoretical review is supplemented by four case-records. Three patients were treated with citalopram. In the firstpatient the authors describe acute dystonia, the second one developed tardive dyskinesia andparkinsonism, the third one acute dystonia. The last case suffered from parkinsonism caused byfluvoxamine therapy.

Key words:
extrapyramidal syndrome, SSRI, citalopram, fluoxetine, paroxetine, fluvoxamine, ser-traline.