A Case of Akathisia induced by Escitalopram: Case Report & Review of Literature
Bishan Basu, Tanmoy Gangopadhyay, Nivedita Dutta, Bidyut Mandal, Sumitava De and Srikrishna Mondal
Affiliation: Department of Radiotherapy, B.S. Medical College, Bankura, West Bengal, India.
Keywords: Drug-induced Akathisia, Escilopram-induced EPS, SSRI-induced Akathisia, SSRI-induced EPS.
Although cases of Selective Serotonin Reuptake Inhibitor (SSRI) induced akathisia have often been reported in
literature, this adverse effect has not adequately been mentioned in major pharmacology textbooks. As a result, SSRIinduced
akathisia is very frequently under-recognized. A review of literature showed that almost all frequently used SSRIs
such as Fluvoxamine, Fluoxetine, Sertraline, Citalopram have been reported to be causing akathisia. SSRI-induced
restless legs syndrome and movement disorders have also been reported.
However, Escitalopram-induced akathisia is rare. In our review of literature, we could find only one single case of
Escitalopram-induced severe akathisia. And this specific SSRI drug has rarely been implicated with occurrence of restless
legs syndrome and extra-pyramidal side-effects like dytonia etc.
Here, we present a case of Escitalopram-induced severe akathisia - a 53year old female, who had developed severe
akathisia after taking Escitalopram for a few days. According to the Barnes Akathisia Rating Scale (BARS), her Global
Clinical Assessment of Akathisia Score was 5 i.e. severe akathisia. As per Naronjo Adverse Drug Reaction Scale the
probability of association of this adverse reaction with Escitalopram was 7 (i.e. probable). Her symptoms continued in
spite of prompt discontinuation of the drug. But, she improved rapidly with the use of Propranolol and Clonazepam. On
the last follow-up, she was free from any symptoms.
As new generation antidepressants are rarely associated with extra-pyramidal symptoms, the recognition of such adverse
effects requires a high index of suspicion. Early recognition of the symptoms and discontinuation of the offending agent
along with supportive therapy like a short course of benzodiazepines, beta-adrenergic antagonists or anticholinergics may
rapidly relieve the patient from this distressing symptom.
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