Gerber P E, Lynd L D
Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada.
Ann Pharmacother. 1998 Jun;32(6):692-8. doi: 10.1345/aph.17302.
To compile and evaluate all available data suggesting an association between selective serotonin-reuptake inhibitor (SSRI) administration and the occurrence of movement disorders, and to characterize these reactions in terms of onset, duration, treatment and outcome, and potential predisposing factors.
Reports of movement disorders were identified by conducting a comprehensive literature search that included tertiary adverse drug reaction resources, MEDLINE, EmBASE, Biological Abstracts, Current Contents, Reactions, ClinAlert, and International Pharmaceutical Abstracts. In addition, reports were solicited from the Canadian proprietary manufacturers of SSRIs, and from the Therapeutic Products Program of Health Canada. Each case was then classified according to the description of the movement disorder, based on predefined diagnostic criteria.
A total of 127 published reports of SSRI-induced movement disorders were identified involving akathisia (n = 30), dystonia (19), dyskinesia (12), tardive dyskinesia (6), parkinsonism (25), and 15 cases of mixed disorders. Ten isolated cases of bruxism were identified. Ten additional reports could not be classified. Manufacturers of SSRIs provided 49 reports of akathisia, 44 of dystonia, 208 of dyskinesia, 76 of tardive dyskinesia, 516 of parkinsonism, and 60 of bruxism. Treatment strategies included discontinuation of the SSRI; dosage reduction; or the addition of a benzodiazepine, beta-blocker, or anticholinergic agent.
SSRI use appears to be associated with the development of movement disorders, as either a direct result of the drug or exacerbation of an underlying condition. Predisposing factors may include the use of neuroleptics, existing neurologic diagnoses, or preexisting movement disorders. Clinicians should be cognizant of the potential for these reactions, as prompt recognition and management is essential in preventing potentially significant patient morbidity.
汇编并评估所有表明选择性5-羟色胺再摄取抑制剂（SSRI）用药与运动障碍发生之间存在关联的数据，并从发作、持续时间、治疗及转归以及潜在诱发因素方面对这些反应进行特征描述。
通过全面的文献检索来确定运动障碍报告，检索范围包括三级药物不良反应资源库、医学索引数据库（MEDLINE）、荷兰医学文摘数据库（EmBASE）、生物学文摘数据库、当期期刊目次数据库、药物不良反应数据库（Reactions）、临床警报数据库（ClinAlert）以及国际药学文摘数据库。此外，还向加拿大SSRI专利药品制造商以及加拿大卫生部治疗产品计划处征集报告。然后根据预定义的诊断标准，依据运动障碍的描述对每个病例进行分类。
共识别出127篇关于SSRI诱发运动障碍的已发表报告，其中包括静坐不能（30例）、肌张力障碍（19例）、运动障碍（12例）、迟发性运动障碍（6例）、帕金森综合征（25例）以及15例混合性障碍。还识别出10例单独的磨牙症病例。另有10篇报告无法分类。SSRI制造商提供了49篇静坐不能报告、44篇肌张力障碍报告、208篇运动障碍报告、76篇迟发性运动障碍报告、516篇帕金森综合征报告以及60篇磨牙症报告。治疗策略包括停用SSRI；减少剂量；或加用苯二氮䓬类药物、β受体阻滞剂或抗胆碱能药物。
使用SSRI似乎与运动障碍的发生有关，这可能是药物的直接作用，也可能是使潜在疾病加重所致。诱发因素可能包括使用抗精神病药物、现有神经学诊断或既往存在的运动障碍。临床医生应认识到这些反应的可能性，因为及时识别和处理对于预防患者可能出现的严重发病情况至关重要。
