The effect of antipsychotics on the dopamine pathways in particular the nigro-striatal system is well known and documented as well as the short and long term extrapyramidal side effects.
But we have any scientific and /or clinical evidence that even SSRIs in chronic treatment, even at low doses, can induce Parkinson-like side effects?
Of course, even SSRIs can cause extrapyramidal as well as other side effects in patients with Parkinson's disease. However, in the recent meta-analysis with antidepressant treatment in depression in the context of Parkinson's disease (Zhuo et al., 2017), SSRIs have not only been the most effective but also the safest drugs. I personally also have a very good clinical experience with agomelatine in patients with Parkinson's disease.
Thank you Michal, I do agree with you. But my question was if the only treatment with SSRIs can induce Parkinson's like disorders. Have you any experience about it?
Sorry that I missed the point. I have never seen parkinsonism after SSRI treatment. Did you ever see it? If it appears, it is very probable that it is only an unveiling of Parkinson's disease. What do you think about it?
I have two cases of patients treated only with BDZ and SSRIs and after many years they developed parkinsonism, probably iatrogenic. Indeed they both have neither familiarity and risk factors for PD. Moreover they are both smokers and smoking is considered a protective factor. My idea is that unbalance of serotonin metabolism for too many years may have altered the pre and post-synaptic receptors asset. Needless to say also the BDZ could play a decisive role at all.
Very low doses ssri for long duration produce histological changes in body organs ( genito urinary system). Probably low doses also produces changes in nervous system which causes parkinsonism .
Alkra, please can you tell me something more about changes produced in genito- urinary system by long duration therapy with SSRI?
I am currently working on side effects from serotonin reuptake inhibitors.
I would say, mechanistically, yes!
By inhibiting the serotonin pump, SSRIs increases serotonin in the synaptic cleft which can stimulate postsynaptic 5HT2A receptors which can result in EPS. Blocking of these later receptors ushered the sparkle of atypical antipsychotics with lower propensity to EPS.
Moreover, long-term use has been associated with secondary DA deficiency and frontal lobe dysfunction hence the well recognized syndrome of 'emotional blunting'
So, in my experience, I prefer to use either paroxetine or sertraline to treat MDD associated with PD. Paroxetine has intrinsic anticholinergic properties so it mitigate this (theoretical) risk of aggravating PD. Sertraline, at higher doses, inhibit DA transporter so it counterbalances this risk.
- Badges
- Science topic
- Similar topics
- Chemistry
- Pharmacology
- Pharmaceuticals
- Drugs