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Schneider AL. Putative Mechanism of Action of Trazodone-Related Oromandibular Dyskinesia. Case Rep Psychiatry 2024; 2024:5543023. [PMID: 38585414 PMCID: PMC10999284 DOI: 10.1155/2024/5543023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/11/2024] [Accepted: 03/23/2024] [Indexed: 04/09/2024] Open
Abstract
This is a case report of three cases of trazodone-induced buccal-lingual dyskinesias. Each case demonstrated the distinct pattern of the development of this dyskinesia after trazodone exposure for several months. All cases showed abrupt cessation of the movement disorder when the drug was discontinued. One of the three cases demonstrated a highly unusual presentation of an on/off pattern of buccal dyskinesia directly related to repetitive exposure and termination of the drug trazodone. Two of the three cases had no prior exposure to any dopamine blocking agents. One of the three had a distant exposure to a dopamine antagonist. As opposed to other antidepressants, trazodone has a mechanism of action which can account for both the development and treatment of dyskinetic movements. Its metabolite, M/chlorophenylpiperazine (M-CPP) is a 5HT2C agonist capable of causing abnormal oral-facial movements in rodent models. The presence of oromandibular dyskinetic movements can occur spontaneously with age, with trazodone being a potential predisposing factor. This article will discuss proposed mechanisms for trazodone's action with an emphasis on case reports of dystonic movements.
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Affiliation(s)
- Alan L. Schneider
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
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Yajnik K, Thakar N, Chovatiya H, Desai S. Trazodone-Associated Extrapyramidal Syndrome: A Case Report and Review of Literature. Ann Indian Acad Neurol 2024; 27:85-87. [PMID: 38495228 PMCID: PMC10941900 DOI: 10.4103/aian.aian_774_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/01/2023] [Accepted: 10/06/2023] [Indexed: 03/19/2024] Open
Affiliation(s)
- Krushan Yajnik
- Department of Medicine, Shree Krishna Hospital and Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India
| | - Nirav Thakar
- Department of Medicine, Shree Krishna Hospital and Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India
| | | | - Soaham Desai
- Department of Neurology, Shree Krishna Hospital and Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India
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Lin MC, Chang YY, Lee Y, Wang LJ. Tardive sensory syndrome related to lurasidone: A case report. World J Psychiatry 2023; 13:126-130. [PMID: 37033893 PMCID: PMC10075022 DOI: 10.5498/wjp.v13.i3.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/17/2022] [Accepted: 02/15/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Tardive sensory syndrome (TSS) is a subtype of tardive syndrome (TS), and its etiology is still uncertain. Lurasidone is an atypical antipsychotic that has high affinity for dopamine D2- and serotonergic 5HT2A- and 5-HT7-receptors.
CASE SUMMARY A 52-year-old woman, previously diagnosed with schizophrenia, and with no history of movement disorders and no sensory paresthesia, had taken lurasidone, initiate dose 40 mg daily then up titration to 120 mg daily, since March 2021, and developed mandibular sensory (pain) paresthesia after 3 mo of administration. After switching from lurasidone to quetiapine, she reported obvious impr-ovement in her mandibular pain.
CONCLUSION It is noteworthy that TSS is a rare subtype of TS, and lurasidone, an atypical antipsychotic, usually has a lower risk of causing TS. In light of the temporal relationship, it is therefore concluded that use of lurasidone might have caused TSS in this patient. We reported this rare case as a reminder that clinicians should adopt a cautious approach when prescribing atypical antipsychotics, so as to prevent TS.
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Affiliation(s)
- Mei-Chun Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine Kaohsiung, Kaohsiung 83301, Taiwan
| | - Yung-Yee Chang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine Kaohsiung, Kaohsiung 83301, Taiwan
| | - Yu Lee
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine Kaohsiung, Kaohsiung 83301, Taiwan
| | - Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
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Skarmeta NP, Katzmann GC, Valdés C, Gaedechens D, Montini FC. Tardive Oromandibular Dystonia Induced by Trazodone: A Clinical Case and Management from the Perspective of the Dental Specialist. Toxins (Basel) 2022; 14:toxins14100680. [PMID: 36287949 PMCID: PMC9607571 DOI: 10.3390/toxins14100680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/06/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Tardive Oromandibular Dystonia is an iatrogenic drug-induced movement form of extrapyramidal symptoms associated primarily with chronic consumption of dopamine receptor blocking agents. Tardive symptoms attributable to selective serotonin reuptake inhibitors antidepressants are far less prevalent. CLINICAL CASE The authors will present a clinical case and management, from the dental specialist perspective, of a 55-year-old female patient who developed tardive oromandibular dystonia induced by Trazodone prescribed for sleep insomnia. CONCLUSIONS Trazodone-induced oromandibular dystonia is extremely rare. Early identification and assessment of tardive symptoms are imperative for successful treatment. Trazodone should be prescribed with caution in patients taking other medications with the potential to cause tardive syndromes.
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Affiliation(s)
- Nicolás P. Skarmeta
- Facultad de Odontología, Universidad de los Andes, Santiago 7620001, Chile
- Hospital del Salvador, Providencia 7500922, Chile
- OPH Clinic, Vitacura 7630000, Chile
| | - Giannina C. Katzmann
- Facultad de Odontología, Universidad de los Andes, Santiago 7620001, Chile
- Hospital del Salvador, Providencia 7500922, Chile
| | - Constanza Valdés
- Facultad de Odontología, Universidad de los Andes, Santiago 7620001, Chile
| | | | - Francisca C. Montini
- Facultad de Odontología, Universidad de los Andes, Santiago 7620001, Chile
- Correspondence: ; Tel.: +56-2-2618-1372
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Kadota Y, Hori H, Takayama M, Okabe C, Ohara N. Tardive dystonia improved with discontinuation of trazodone in an elderly schizophrenia patient: a case report. Ann Gen Psychiatry 2020; 19:23. [PMID: 32265999 PMCID: PMC7114810 DOI: 10.1186/s12991-020-00273-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tardive dystonia associated with antidepressant use is rare and often under-recognized. We had an experience with trazodone, which is used for delirium and insomnia prescribed in general hospital, inducing tardive dystonia. CASE PRESENTATION A 61-year-old Japanese woman had been treated for schizophrenia. She was moved to general hospital because of consciousness disturbance. She was prescribed trazodone (25 mg/day) for delirium and insomnia. After she was discharged, she returned to the psychiatric hospital with tardive dystonia. Her dystonia symptoms improved with 3 days of discontinuing trazodone. CONCLUSION In the present case, long-term use of trazodone induced tardive dystonia. Discontinuing trazodone rapidly improved tardive dystonia.
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Affiliation(s)
- Yoshinori Kadota
- Minamigaoka Hospital, 3-13-1 Imamachi, Kokurakita-ku, Kitakyushu, Fukuoka 8030862 Japan
| | - Hikaru Hori
- Minamigaoka Hospital, 3-13-1 Imamachi, Kokurakita-ku, Kitakyushu, Fukuoka 8030862 Japan.,2Department of Psychiatry, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 8078555 Japan
| | - Michiko Takayama
- Minamigaoka Hospital, 3-13-1 Imamachi, Kokurakita-ku, Kitakyushu, Fukuoka 8030862 Japan
| | - Chikako Okabe
- Minamigaoka Hospital, 3-13-1 Imamachi, Kokurakita-ku, Kitakyushu, Fukuoka 8030862 Japan
| | - Naotoshi Ohara
- Minamigaoka Hospital, 3-13-1 Imamachi, Kokurakita-ku, Kitakyushu, Fukuoka 8030862 Japan
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Abstract
The term tardive syndrome (TS) encompasses a few different phenomenologic conditions, some of which occur in isolation and others in association with each other. This, along with the unusual confound for a drug side effect, in which increased use of the drug improves the problem, and the need for most patients to continue taking the offending drug, makes understanding the epidemiology difficult and unreliable. While the change from the "first generation" to the "second generation" of antipsychotic drugs is generally believed to have reduced the incidence of TS, prospective research studies have not supported that contention. Published reports have found point prevalences of 13% with second generation antipsychotics and 32% with first, yet others have found no differences. One study found increasing rates of TS with a 68% prevalence by 25 years, while another found a decreased prevalence over time, due presumably to masking effects of the antipsychotic drugs. Regardless of the possible differences, it is clear that TS remains a significant and common problem associated with almost all antipsychotic drugs. There have also been scattered reports of TS caused by drugs not known to inhibit dopamine receptors. These are reviewed and were found to be often of dubious reliability.
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Affiliation(s)
- Anelyssa D'Abreu
- Brown University, Department of Neurology, Providence, RI, United States; Rhode Island Hospital, Department of Neurology, Providence, RI, United States.
| | - Umer Akbar
- Brown University, Department of Neurology, Providence, RI, United States; Rhode Island Hospital, Department of Neurology, Providence, RI, United States
| | - Joseph H Friedman
- Brown University, Department of Neurology, Providence, RI, United States; Butler Hospital, Department of Neurology, Providence, RI, United States
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Abstract
Bupropion is an antidepressant that is effective in the treatment of major depressive disorders, smoking cessation, and sexual side effects of selective serotonin reuptake inhibitors. Acute dystonia is characterized by prolonged muscle contraction often represented by spasms of the head and neck muscles as well as occasional jaw clenching and temporomandibular joint syndrome. Although it is believed that dystonia is the result of an abnormality of the basal ganglia, its pathophysiology is still unclear. A few cases of dystonia resulting from bupropion have been reported in prior research papers. This case report discusses a patient who had a neck spasm painful enough to wake him up and dystonic distortion after taking only one dose of 75 mg bupropion. The patient was a young 34-year-old man with a diagnosis of obsessive-compulsive disorder treated with 60 mg fluoxetine. Bupropion was added to his medications because of sexual side effects caused by the fluoxetine. It seems that we must be careful to watch for dystonic symptoms when bupropion is mixed with other drugs that affect serotonin reuptake. Although dystonia is a rare side effect of bupropion, physicians should be aware of it and manage it if it occurs.
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Affiliation(s)
- Forouzan Elyasi
- Department of Psychiatry, Psychiatry and Behavioral Sciences Research Center, School of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
| | - Elham Mahtiyan
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
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Abstract
Hyperkinetic movement disorders are characterized by excess movement, and include chorea, akathesia, asterixis, dystonia, tremor, myoclonus, and tics. A wide variety of pharmacologic agents may induce or exacerbate these disorders. Neuroleptic-induced tardive dyskinesia and levodopa-induced hyperkinesia are the most common causes of medication-induced chorea. However, several nonneuroleptic agents, including antidepressants and antiepileptic medications, may also worsen hyperkinetic movement disorders. Over-the-counter medications, such as analgesics and antiheartburn medications, have also occasionally been implicated as causing hyperkinetic movement disorders. Most information regarding drug-induced hyperkinetic disorders comes from case reports and anecdotes, rather than controlled clinical trials. Further research with larger controlled trials needs to verify many of these findings.
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Chen PY, Lin PY, Tien SC, Chang YY, Lee Y. Duloxetine-related tardive dystonia and tardive dyskinesia: a case report. Gen Hosp Psychiatry 2010; 32:646.e9-646.e11. [PMID: 21112461 DOI: 10.1016/j.genhosppsych.2010.04.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 04/27/2010] [Accepted: 04/27/2010] [Indexed: 10/19/2022]
Abstract
Tardive dyskinesia and tardive dystonia are caused by dopamine receptor blocking agents, mostly antipsychotics and sometimes antidepressants or calcium channel blockers. Duloxetine-related tardive syndrome is rarely reported in the literature. We report one case of tardive dystonia and tardive dyskinesia occurring in a 58-year-old female with major depressive disorder, who developed distressing oral dyskinesia, mandibular dystonia with trismus and dystonia over left neck after treatment of duloxetine (30-60 mg per day) for 18 months. Despite discontinuation of duloxetine, she only obtained partial remission. Even though this association has been rarely reported, duloxetine may pose a potential risk of inducing tardive syndrome. Clinicians should cautiously detect early signs of movement abnormality when prescribing antidepressants.
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Affiliation(s)
- Pei-Yi Chen
- Department of Psychiatry, Chang Gung University College of Medicine, Kaohsiung County, 83301, Taiwan
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2009. [DOI: 10.1002/pds.1645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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