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Association of Antidepressant Use With Drug-Related Extrapyramidal Symptoms: A Pharmacoepidemiological Study.
J Clin Psychopharmacol. 2018 Aug; 38(4):349-356.JC

Abstract

BACKGROUND

Antidepressants are one of the most prescribed classes of medications. A number of case reports have linked these drugs to extrapyramidal symptoms (EPSs), but no large epidemiologic study to date has examined this association. We sought to quantify the association of EPSs with different antidepressants by undertaking a large pharmacoepidemiologic study.

METHODS

A nested case-control study was conducted using a large health claims database in the United States from June 2006 to December 2015. Subjects with a diagnosis of primary Parkinson disease and those who received prescriptions of levodopa, ropinirole, pramipexole, domperidone, metoclopramide, entacapone, benztropine, selegiline, rasagiline, diphenhydramine, trihexyphenidyl, typical and atypical antipsychotics, and tricyclic antidepressants were excluded. Cases were followed to the first billing code for an extrapyramidal event or last date of enrollment in the cohort. For each case, 10 control subjects were matched by follow-up time, calendar time, and age through density-based sampling. Rate ratios were computed using conditional logistic regression adjusting for other covariates.

RESULTS

We identified 3,838 subjects with EPSs compared with 38,380 age-matched control subjects. Rate ratios with respect to EPSs were as follows: duloxetine, 5.68 (95% confidence interval [CI], 4.29-7.53); mirtazapine, 3.78 (95% CI, 1.71-8.32); citalopram, 3.47 (95% CI, 2.68-4.50); escitalopram, 3.23 (95% CI, 2.44-4.26); paroxetine, 3.07 (95% CI, 2.15-4.40); sertraline, 2.57 (95% CI, 2.02-3.28); venlafaxine, 2.37 (95% CI, 1.71-3.29); bupropion, 2.31 (95% CI, 1.67-3.21); and fluoxetine, 2.03 (95% CI, 1.48-2.78).

CONCLUSIONS

This observational study demonstrates a harmful association between the incidence of Parkinson disease or associated EPSs and use of the antidepressants duloxetine, mirtazapine, citalopram, escitalopram, paroxetine, sertraline, venlafaxine, bupropion, and fluoxetine.

Authors+Show Affiliations

No affiliation info availableDepartments of Ophthalmology and Visual Sciences.Psychiatry, and.Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada.Department of Neurology, University of Washington, Seattle, WA.Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec.Child & Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29901567

Citation

Guo, Michael Y., et al. "Association of Antidepressant Use With Drug-Related Extrapyramidal Symptoms: a Pharmacoepidemiological Study." Journal of Clinical Psychopharmacology, vol. 38, no. 4, 2018, pp. 349-356.
Guo MY, Etminan M, Procyshyn RM, et al. Association of Antidepressant Use With Drug-Related Extrapyramidal Symptoms: A Pharmacoepidemiological Study. J Clin Psychopharmacol. 2018;38(4):349-356.
Guo, M. Y., Etminan, M., Procyshyn, R. M., Kim, D. D., Samii, A., Kezouh, A., & Carleton, B. C. (2018). Association of Antidepressant Use With Drug-Related Extrapyramidal Symptoms: A Pharmacoepidemiological Study. Journal of Clinical Psychopharmacology, 38(4), 349-356. https://doi.org/10.1097/JCP.0000000000000911
Guo MY, et al. Association of Antidepressant Use With Drug-Related Extrapyramidal Symptoms: a Pharmacoepidemiological Study. J Clin Psychopharmacol. 2018;38(4):349-356. PubMed PMID: 29901567.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of Antidepressant Use With Drug-Related Extrapyramidal Symptoms: A Pharmacoepidemiological Study. AU - Guo,Michael Y, AU - Etminan,Mahyar, AU - Procyshyn,Ric M, AU - Kim,David D, AU - Samii,Ali, AU - Kezouh,Abbas, AU - Carleton,Bruce C, PY - 2018/6/15/pubmed PY - 2018/10/16/medline PY - 2018/6/15/entrez SP - 349 EP - 356 JF - Journal of clinical psychopharmacology JO - J Clin Psychopharmacol VL - 38 IS - 4 N2 - BACKGROUND: Antidepressants are one of the most prescribed classes of medications. A number of case reports have linked these drugs to extrapyramidal symptoms (EPSs), but no large epidemiologic study to date has examined this association. We sought to quantify the association of EPSs with different antidepressants by undertaking a large pharmacoepidemiologic study. METHODS: A nested case-control study was conducted using a large health claims database in the United States from June 2006 to December 2015. Subjects with a diagnosis of primary Parkinson disease and those who received prescriptions of levodopa, ropinirole, pramipexole, domperidone, metoclopramide, entacapone, benztropine, selegiline, rasagiline, diphenhydramine, trihexyphenidyl, typical and atypical antipsychotics, and tricyclic antidepressants were excluded. Cases were followed to the first billing code for an extrapyramidal event or last date of enrollment in the cohort. For each case, 10 control subjects were matched by follow-up time, calendar time, and age through density-based sampling. Rate ratios were computed using conditional logistic regression adjusting for other covariates. RESULTS: We identified 3,838 subjects with EPSs compared with 38,380 age-matched control subjects. Rate ratios with respect to EPSs were as follows: duloxetine, 5.68 (95% confidence interval [CI], 4.29-7.53); mirtazapine, 3.78 (95% CI, 1.71-8.32); citalopram, 3.47 (95% CI, 2.68-4.50); escitalopram, 3.23 (95% CI, 2.44-4.26); paroxetine, 3.07 (95% CI, 2.15-4.40); sertraline, 2.57 (95% CI, 2.02-3.28); venlafaxine, 2.37 (95% CI, 1.71-3.29); bupropion, 2.31 (95% CI, 1.67-3.21); and fluoxetine, 2.03 (95% CI, 1.48-2.78). CONCLUSIONS: This observational study demonstrates a harmful association between the incidence of Parkinson disease or associated EPSs and use of the antidepressants duloxetine, mirtazapine, citalopram, escitalopram, paroxetine, sertraline, venlafaxine, bupropion, and fluoxetine. SN - 1533-712X UR - https://www.unboundmedicine.com/medline/citation/29901567/Association_of_Antidepressant_Use_With_Drug-Related_Extrapyramidal_Symptoms:_A_Pharmacoepidemiological_Study L2 - http://dx.doi.org/10.1097/JCP.0000000000000911 DB - PRIME DP - Unbound Medicine ER -