Efficacy of aripiprazole in antidepressants-induced tardive dystonia and tardive dyskinesia: a case report.

Tardive syndromes (TDS) are a group of movement disorders. Tardive dyskinesia is the best-known type of TDS. Another type of TDS is tardive dystonia. TDS cause body parts to move uncontrollably. Tardive dyskinesia and tardive dystonia are caused by dopamine receptor blocking agents, mostly antipsychotics but occasionally antidepressants (Jankovic 1995). However, tardive dystonia associated with antidepressants is rare and often under-recognized (Lee et al. 2013). There is one case that shows duloxetine-related tardive dystonia and tardive dyskinesia (Chen et al. 2010). The extrapyramidal symptoms (EPS) reported with tricyclic antidepressant (TCA) monotherapy appear to be unrelated to age but are often dose-related (Gill et al. 1997). Other risk factors include prior exposure to neuroleptics and/or lithium or estrogens. In some cases, the EPS resolve without any reduction of the TCA dose (Gill et al. 1997). It has been theorized that serotonin reuptake inhibition exerts an indirect dopamine blocking effect. Experiments on monkeys have demonstrated that SSRIs can induce dyskinetic movements (Korsgaard et al. 1985). To our knowledge, there is no previous report on whether aripiprazole, a dopamine partial agonist, improves tardive dystonia and tardive dyskinesia simultaneously. Herein, we report on the case of a patient with major depressive disorder who was treated with aripiprazole for tardive dystonia and tardive dyskinesia, which were developed after long-term administration of amitriptyline, trazodone and short-term treatment with escitalopram.