De Novo Onset of Parkinson's Disease After Antidepressant Treatment With Citalopram

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Abstract
Serotonin inhibits dopaminergic transmission in both substantia nigra and striatum [ 1 ]. While this interaction is of obvious importance for the understanding of the actions of antipsychotics, the serotoninergic inhibition of dopamine release can also - although rarely - lead to dopaminergic side-effects of selective serotonin reuptake inhibitors (SSRIs) [ 1 ] [ 2 ]. A variety of extrapyramidal symptoms, ranging from tremor to dystonic reactions, from akathisia-like syndromes to parkinsonian symptoms have been described, with this phenomenon occurring in approx. 1/1000 individuals treated with SSRIs [ 2 ]. It is unclear whether the fact that some SSRIs (e. g. sertraline) also show intrinsic dopaminergic properties [ 3 ] has some influence on this phenomenon. Citalopram, a drug widely used in Europe for the treatment of depression, has been described as the most selective of serotonin reuptake inhibitors [ 4 ]. It has no effect on dopamine reuptake and no antagonistic activity towards dopamine receptors [ 5 ]. It has been prescribed to more than 600,000 patients in the period between 1989 and 1996. An integrated safety database including data from 3107 patients from 24 clinical trials showed only two reports of extrapyramidal or movement disorder - one patient had previously been diagnosed as having Parkinson's disease, and the other was receiving concomitant neuroleptic treatment [ 4 ]. In a study on the use of citalopram in Parkinson's disease and tardive dyskinesia, no significant effects on tardive dyskinesia, parkinsonism or eye-blinking rate were observed during treatment (20 - 40 mg/day for 3 weeks) [ 6 ].

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