Objective: To represent a case of acute dystonic dyskinesias after fluvoxamine use by the patient with obsessive thoughts and movements.

Background: In psychiatric clinical practice, drug-induced movement disorders can be caused by different groups of drugs. Most of them are caused by antipsychotic drugs. However, it is worth remembering that other groups of drugs, such as antidepressants, anticonvulsants, mood stabilizers, when used in therapeutic dosages, can also cause motor disorders [1-3].

Method: In 2023, patient B, 37, referred to psychiatrist for the first time with complaints of anxiety, rituals, fatigue. From the age of 12-13, he often washed hands five times in a row, because of a feeling that “had not washed completely”, was afraid of germs, washed for 2-5 minutes for 6 months, then began to wash my hands normally. As a student, he declares “bad thoughts”, that diminished by reading “good things”. During the pandemic, rituals appeared and intensified. The diagnosis was made: Mixed obsessive thoughts and actions. It was recommended to take fluvoxamine according to the 0-0-50 mg regimen, with gradual titration once a week of 25 mg to 225 mg / day, orally. Three months after fluvoxamine begin, the patient contacted doctor with complaints on bad sleeping and muscle twitching in the right arm, leg and face. He was taking fluvoxamine 50-0-175 mg scheme.

It was recommended to reduce fluvoxamine 0-0-125 mg, inside, increase fluid intake and the patient was referred to Republican Center for Movement Disorders (Kazan).

Results: Examined by a neurologist: irregular dystonic hyperkinesis of the orobuccolingual region involving platysma, which increased with arbitrary movements, conversation; non-stereotypical, irregular dyskinesia with a tonic component in the right lower limb in the form of toes’ bending with impaired gait steadiness and pain up to 6 points by visual analogue scale (VAS), as well as dystonic hyperkinesis in the right upper limb. Dyskinesia in extremities did not depend on the time of day and was not provoked by movements.

It was recommended to cancel fluvoxamine. The patient underwent a course of intravenous amantadine sulfate 400 mg for 8 days followed by tablets (100 mg). A week after the withdrawal and treatment beginning, a complete regression of symptoms observed.

Conclusion: It is recommended to prescribe SSRIs with caution.

References: 1. Pandey S, Pitakpatapee Y, Saengphatrachai W, Chouksey A, Tripathi M, Srivanitchapoom P. Drug-Induced Movement Disorders. Semin Neurol. 2023 Feb;43(1):35-47. doi: 10.1055/s-0043-1763510. Epub 2023 Feb 24 PMID: 36828011
2. Zádori D, Veres G, Szalárdy L, Klivényi P, Vécsei L. Drug-induced movement disorders. Expert Opin Drug Saf. 2015 Jun;14(6):877-90. doi: 10.1517/14740338.2015.1032244. PMID: 25981904
3. Rodnitzky RL. Drug-induced movement disorders in children. Semin Pediatr Neurol. 2003 Mar;10(1):80-7. doi: 10.1016/s1071-9091(02)00013-x. PMID: 12785751

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MDS Abstracts - https://www.mdsabstracts.org/abstract/acute-dystonic-dyskinesias-in-a-patient-used-fluvoxamine-case-report/