Reactions 1330 - 4 Dec 2010

SCitalopram

Tardive dyskinesia and akathisia: case reportA 26-year-old man developed tardive dyskinesia and

akathisia during treatment with citalopram for depression.The man was diagnosed with depression secondary to

traumatic brain injury and commenced oral citalopram20mg daily with other medications. He reported worseningdepression at a follow-up appointment 6 months later andan increase in his citalopram dosage to 40 mg/day wasprescribed. A 3-month follow-up appointment wasscheduled, but 6 weeks later he returned, reportinguncontrollable movements of the muscles of the trunk,limbs and face. An inability to sit still with apparentrestlessness, involuntary limb movements, and abnormalfacial grimacing had started suddenly. Upon review of hismedication, it was found that he had not increased thecitalopram dosage as previously prescribed. He had beenevaluated for suicidal ideation 2 days prior to the onset ofthe abnormal movements, which had prompted him toincrease his citalopram to 40 mg/day; he had woken withminimal hand-jerking the following morning. In addition tohis other medications, he was also smoking 2 marijuanacigarettes per day. Significant involuntary movements of hisextremities occurring 1-2 times/minute, visible facialgrimacing occurring 5-6 times/minute and his inability to sitstill were apparent on examination.

Over 7 days, citalopram was gradually tapered. To helpwith the movement disorder, clonazepam was added to theman’s treatment. At next follow-up, the tardive dyskinesiahad significantly decreased to one episode every4–5 minutes and the akathisia had completely resolved.Fluoxetine was then prescribed for his depression. Themovements were reported in a telephone conversation tobe significantly decreased in intensity and frequency, butnot completely resolved, at last follow-up.Birthi P, et al. A rare case of tardive dyskinesia and akathisia induced bycitalopram. P M & R 2: 973-975, No. 10, Oct 2010. Available from: URL: http://dx.doi.org/10.1016/j.pmrj.2010.05.007 - USA 803044654

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Reactions 4 Dec 2010 No. 13300114-9954/10/1330-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved