Reactions 826 - 4 Nov 2000

★ SCitalopram

First report of Parkinson’s disease in an elderlypatient: case report

Citalopram therapy for major depression was associatedwith the onset of Parkinson’s disease in a 68-year-old woman.

The woman started treatment with citalopram [‘Cipramil’]20 mg/day when she was assessed for massive suicidalthoughts and depression. During the previous year, she hadalso experienced episodes of anxiety and sleeplessness. Sevendays after starting citalopram, she was hospitalised with severeparkinsonian symptoms including rigidity, bradykinesia andtremor. The next day, her symptoms worsened: she was notable to walk or turn over in bed without help, her facialmovements were hypokinetic and her handwriting wasillegible. Two days later, the dosage of citalopram wasincreased to 40 mg/day and her parkinsonian symptomsworsened. The dosage of citalopram was reduced the next day[dosage not stated]. After a further 2 days’ therapy, citalopramwas discontinued and antidepressant therapy was continuedwith nortriptyline; however, her parkinsonian symptomspersisted.

Test doses of levodopa and benserazide were administered10 days after citalopram was stopped. The woman’sparkinsonian symptoms considerably improved and treatmentwith these agents was continued. Subsequently, cabergolinewas added to her regimen and her parkinsonian symptomsresolved. Three weeks later, her depression had remitted. 44days after admission to hospital, she was discharged receivingnortriptyline therapy. A final diagnosis of Parkinson’s diseasewas made.

Author comment: ‘Although we cannot exclude that, in thispatient, the Parkinson’s disease onset had been a coincidence,we suggest that, in our case, a sub-threshold dopaminergiclesion was already present when citalopram was started, andthat the increase of serotoninergic inhibition of dopaminergicfunction lead to the clinical de novo manifestation ofParkinson’s disease.’Stadtland C, et al. De Novo onset of Parkinson’s disease after antidepressanttreatment with citalopram. Pharmacopsychiatry 33: 194-195, Sep 2000 -Germany 800843981

» Editorial comment: A search of AdisBase and Medline didnot reveal any previous case reports of Parkinson’s diseaseassociated with citalopram.

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Reactions 4 Nov 2000 No. 8260114-9954/10/0826-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved