Leo R J
Department of Psychiatry, School of Medicine, State University of New York at Buffalo 14215, USA.
J Clin Psychiatry. 1996 Oct;57(10):449-54. doi: 10.4088/jcp.v57n1002.
To review the case reports and case series of movement disorders ascribed to the use of serotonin selective reuptake inhibitors (SSRIs).
Reports of SSRI-induced extrapyramidal symptoms (EPS) in the literature were located using a MEDLINE search and review of bibliographies.
Among the 71 cases of SSRI-induced EPS reported in the literature, the most common side effect was akathisia (45.1%), followed by dystonia (28.2%), parkinsonism (14.1%), and tardive dyskinesia-like states (11.3%). Among patients with Parkinson's disease treated with SSRIs, there were 16 cases of worsening parkinsonism. Patients who developed dystonia, parkinsonism, or tardive dyskinesia were older on average than patients with akathisia; 67.6% of affected patients were females. Fluoxetine, the most commonly prescribed SSRI to date, was implicated in 53 (74.6%) of cases of SSRI-induced EPS. Several reports (57.7%) were confounded by the concomitant use of other medications that can contribute to the development of EPS.
SSRI-induced EPS are probably related to agonism of serotonergic input to dopaminergic pathways within the CNS. Several patient-dependent and pharmacokinetic variables may determine the likelihood that EPS will emerge. Although these side effects are infrequent, clinicians should be alert to the possibility of their occurrence.
回顾归因于使用5-羟色胺再摄取抑制剂（SSRI）的运动障碍的病例报告和病例系列。
通过医学文献数据库检索及参考文献回顾，查找文献中有关SSRI诱发锥体外系症状（EPS）的报告。
文献中报告的71例SSRI诱发的EPS病例中，最常见的副作用是静坐不能（45.1%），其次是肌张力障碍（28.2%）、帕金森症（14.1%）和迟发性运动障碍样状态（11.3%）。在接受SSRI治疗的帕金森病患者中，有16例帕金森症状加重。出现肌张力障碍、帕金森症或迟发性运动障碍的患者平均年龄比静坐不能患者大；67.6%的受影响患者为女性。氟西汀是迄今为止最常处方的SSRI，在53例（74.6%）SSRI诱发的EPS病例中被提及。几份报告（57.7%）因同时使用其他可导致EPS发生的药物而混淆。
SSRI诱发的EPS可能与中枢神经系统内多巴胺能途径的5-羟色胺能输入激动有关。几个患者相关和药代动力学变量可能决定EPS出现的可能性。尽管这些副作用不常见，但临床医生应警惕其发生的可能性。
