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Muacevic A, Adler JR. Bupropion-Induced Dystonia: A Case Report. Cureus 2022; 14:e29857. [PMID: 36337825 PMCID: PMC9627898 DOI: 10.7759/cureus.29857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 01/24/2023] Open
Abstract
Bupropion is one of the most commonly prescribed antidepressant medications by physicians all over the world. Because of its favorable sexual profile, it is used as an alternative to serotonin reuptake inhibitors (SSRIs). Its significance in smoking cessation is also well recognized. However, it is associated with a few side effects, such as dizziness, anxiety, tremors, nausea, and insomnia. We present the case of a 54-year-old chronic smoker who developed acute facial dystonia involving the temporomandibular joint (TMJ) after being prescribed 300 mg of bupropion. The Naranjo scale was used to assess the probability of bupropion-induced dystonia. Following the diagnosis, the drug was stopped, and the dystonia completely resolved within one week. At her follow-ups, the patient was found to have no recurrence of dystonia.
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Cosci F, Chouinard G. Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 89:283-306. [PMID: 32259826 DOI: 10.1159/000506868] [Citation(s) in RCA: 119] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 02/27/2020] [Indexed: 11/19/2022]
Abstract
Studies on psychotropic medications decrease, discontinuation, or switch have uncovered withdrawal syndromes. The present overview aimed at analyzing the literature to illustrate withdrawal after decrease, discontinuation, or switch of psychotropic medications based on the drug class (i.e., benzodiazepines, nonbenzodiazepine benzodiazepine receptor agonists, antidepressants, ketamine, antipsychotics, lithium, mood stabilizers) according to the diagnostic criteria of Chouinard and Chouinard [Psychother Psychosom. 2015;84(2):63-71], which encompass new withdrawal symptoms, rebound symptoms, and persistent post-withdrawal disorders. All these drugs may induce withdrawal syndromes and rebound upon discontinuation, even with slow tapering. However, only selective serotonin reuptake inhibitors, serotonin noradrenaline reuptake inhibitors, and antipsychotics were consistently also associated with persistent post-withdrawal disorders and potential high severity of symptoms, including alterations of clinical course, whereas the distress associated with benzodiazepines discontinuation appears to be short-lived. As a result, the common belief that benzodiazepines should be substituted by medications that cause less dependence such as antidepressants and antipsychotics runs counter the available literature. Ketamine, and probably its derivatives, may be classified as at high risk for dependence and addiction. Because of the lag phase that has taken place between the introduction of a drug into the market and the description of withdrawal symptoms, caution is needed with the use of newer antidepressants and antipsychotics. Within medication classes, alprazolam, lorazepam, triazolam, paroxetine, venlafaxine, fluphenazine, perphenazine, clozapine, and quetiapine are more likely to induce withdrawal. The likelihood of withdrawal manifestations that may be severe and persistent should thus be taken into account in clinical practice and also in children and adolescents.
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Affiliation(s)
- Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy, .,Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands,
| | - Guy Chouinard
- Clinical Pharmacology and Toxicology Program, McGill University and Mental Health Institute of Montreal Fernand Seguin Research Centre, University of Montreal, Montreal, Québec, Canada
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Rashidpour P, Poursharif Z, Ayatollahi M, Farzannejad E. Bupropion-induced acute dystonia in a patient with bulimia nervosa: A case report. J Family Med Prim Care 2021; 10:1034-1036. [PMID: 34041117 PMCID: PMC8138415 DOI: 10.4103/jfmpc.jfmpc_1173_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/08/2020] [Accepted: 09/15/2020] [Indexed: 11/04/2022] Open
Abstract
Bupropion is taken as an antidepressant for treatment of major depressive disorders, treatment of sexual side effects of selective serotonin reuptake inhibitors, and as a smoking cessation aid, however, it may result in adverse effects such as nausea, dry mouth, headache, insomnia, dizziness, anxiety, tremor, and constipation. We investigate the case of a 34-year-old woman with bulimia nervosa where acute dystonia was induced by bupropion in 8 months. Following this diagnosis and after normal tests and MRI results, the patient was advised to discontinue bupropion intake. In the follow-up done 2 weeks later, 3 months later, and 6 months later, no signs of acute dystonia was observed. A physician who administers dopamine blocking agents must be aware of the prevalence of and the risk factors for acute dystonia and also the way of prevention and treatment.
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Affiliation(s)
- Parvane Rashidpour
- Department of Psychiatry, Research Center of Addiction and Behavioral Sciences, Shahid Sadoughi, University of Medical Sciences, Yazd, Iran
| | - Zahra Poursharif
- Department of Psychiatry, Research Center of Addiction and Behavioral Sciences, Shahid Sadoughi, University of Medical Sciences, Yazd, Iran
| | - Mina Ayatollahi
- Department of Psychiatry, Research Center of Addiction and Behavioral Sciences, Shahid Sadoughi, University of Medical Sciences, Yazd, Iran
| | - Elham Farzannejad
- Department of Psychiatry, Research Center of Addiction and Behavioral Sciences, Shahid Sadoughi, University of Medical Sciences, Yazd, Iran
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Kurhan F, Kamış GZ, Çim EFA. Acute dystonia following epileptic seizure after bupropion intoxication. Neurol Sci 2021; 42:4381-4386. [PMID: 33745040 DOI: 10.1007/s10072-021-05139-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 02/22/2021] [Indexed: 12/24/2022]
Abstract
Bupropion is an effective treatment for major depressive disorder and smoking cessation. In this paper, we present a case report about dystonia in the head and the neck after epileptic seizures due to 4200 mg of extended-release bupropion intake, and we aim to take attention to the rare neuropsychiatric side effects that may occur after the use of high doses of bupropion.
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Affiliation(s)
- Faruk Kurhan
- Psikiyatri Anabilim Dalı Tıp Fakültesi, Van Yüzüncü Yıl Üniversitesi, 65100, Van, Türkiye.
| | - Gülsüm Zuhal Kamış
- Department of Psychiatry, Manisa Akhisar Mustafa Kirazoğlu State Hospital, Manisa, Turkey
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Pitton Rissardo J, Fornari Caprara A. Bupropion-associated movement disorders: A systematic review. ANNALS OF MOVEMENT DISORDERS 2020. [DOI: 10.4103/aomd.aomd_35_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Wasif N, Wasif K, Saif MW. Bupropion-Induced Acute Dystonia with Dose Escalation and Use of Naranjo Nomogram. Cureus 2017; 9:e1157. [PMID: 28507829 PMCID: PMC5429148 DOI: 10.7759/cureus.1157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Acute drug-induced dystonia is commonly associated with antipsychotic drugs, antidepressants, antiemetics, and other medications. Bupropion (Wellbutrin and Zyban) is one of the most frequently prescribed antidepressants in the United States and Canada and smoking cessation aid. However, only few reported cases have been published of acute dystonia including dystonia after discontinuation of bupropion and even after a single dose of bupropion. Here, we report another case concerning an acute dystonia resulting from bupropion after dose escalation. To further assess this association, we used the Naranjo nomogram, which is a questionnaire designed for determining the likelihood of whether an adverse drug reaction is actually due to the drug rather than the result of other factors. Our patient’s total score was seven, suggesting that our patient had probable adverse drug reaction. In summary, our case is that selected patients may experience dose-related acute dystonia as adverse reactions to bupropion sustained release (SR). Since it is one of the most commonly prescribed antidepressants and smoking cessation aids, clinicians should be aware of the potential dystonia associated with bupropion.
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Affiliation(s)
- Nawal Wasif
- Tufts Medical Center, Tufts University School of Medicine
| | | | - Muhammad W Saif
- Hematology/Oncology, Tufts Medical Center, Tufts University School of Medicine
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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
Objective Psychosomatic medicine psychiatrists are often tasked with the evaluation and treatment of complex neuropsychiatric states which may be motoric in phenotype. Little energy has been dedicated to understanding acute movement disorders in the hospital environment. Method Recognizing the importance of frontal-subcortical (corticostriatothalamocortical) circuitry and basal ganglia structures, we present a case series of acute movement disorder phenotypes resulting from underlying medical conditions, commonly-administered medications, or the interaction of both. We organize these scenarios into neurodegenerative disorders, primary psychiatric disorders, neuroinflammation, and polypharmacy, demonstrating a clinical example of each followed by background references on a variety of clinical states and medications contributing to acute movement disorders. In addition, we offer visual illustration of implicated neurocircuitry as well as proposed neurotransmitter imbalances involving glutamate, gamma aminobutyric acid, and dopamine. Furthermore, we review the various clinical syndromes and medications involved in the development of acute movement disorders. Results Acute movement disorder's involve complex interactions between frontal-subcortical circuits and acute events. Given the complexity of interactions, psychopharmacological considerations become critical, as some treatments may alleviate acute movement disorders while others will exacerbate them. Conclusion Integrating underlying medical conditions and acutely administered (or discontinued) pharmacological agents offers an interactional, neuromedical approach to acute movement disorders that is critical to the work of psychosomatic medicine.
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Affiliation(s)
- Ifrah Zawar
- 1 Department of Neurology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Mario A Caro
- 2 Department of Psychiatry and Psychology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Lara Feldman
- 2 Department of Psychiatry and Psychology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Xavier F Jimenez
- 2 Department of Psychiatry and Psychology, Cleveland Clinic Foundation, Cleveland, OH, USA.,3 Center for Neurological Restoration, Cleveland Clinic Foundation, Cleveland, OH, USA
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Abstract
Iatrogenic disease is one of the most frequent causes of hospital admissions and constitutes a growing public health problem. The most common type of iatrogenic neurologic disease is pharmacologic, and the central and peripheral nervous systems are particularly vulnerable. Despite this, iatrogenic disease is generally overlooked as a differential diagnosis among neurologic patients. The clinical picture of pharmacologically mediated iatrogenic neurologic disease can range from mild to fatal. Common and uncommon forms of drug toxicity are comprehensively addressed in this chapter. While the majority of neurologic adverse effects are listed and referenced in the tables, the most relevant issues are further discussed in the text.
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Affiliation(s)
- Luciano A Sposato
- Department of Clinical Neurological Sciences, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
| | - Osvaldo Fustinoni
- INEBA Institute of Neurosciences, Buenos Aires, Argentina; Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina.
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Karakaş Uğurlu G, Önen S, Bayındırlı D, Çayköylü A. Acute dystonia after using single dose duloxetine: case report. Psychiatry Investig 2013; 10:95-7. [PMID: 23483133 PMCID: PMC3590439 DOI: 10.4306/pi.2013.10.1.95] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 06/04/2012] [Accepted: 10/05/2012] [Indexed: 11/19/2022] Open
Abstract
Duloxetine is a balanced and potent serotonin and noradrenaline reuptake inhibitor which is known to be effective in depression and anxiety disorders. The common adverse effects include dry mouth, nausea, insomnia, somnolence, dizziness and constipation. Reported adverse effects of the extra pyramidal symptoms (EPS) are rare. In this case, a patient who suffered from acute dystonia, after only one dose of 30 mg duloxetine is presented.
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Affiliation(s)
- Görkem Karakaş Uğurlu
- Department of Psychiatry, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - Sinay Önen
- Department of Psychiatry, Bartın State Hospital, Bartın, Turkey
| | - Deniz Bayındırlı
- Department of Psychiatry, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - Ali Çayköylü
- Department of Psychiatry Ankara, Yıldırım Beyazıt University Ankara Atatürk Training and Research Hospital, Turkey
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2007. [DOI: 10.1002/pds.1380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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