Sertraline and Tic: Case Report

Introduction

Serotonin reuptake inhibitors (SSRIs) including sertraline are among the most widely used drugs for the treatment of depression and obsessive-compulsive disorder. Their safety and tolerability are better than those of the tricyclics, the older antidepressant agents.

The occurrence of extrapyramidal syndromes (EPS), especially akathisia, is a side effect reported with fluoxetine, paroxetine, and sertraline [2] [8] [9] [14]. The interactions between serotonergic and dopaminergic neurotransmitter systems have been assumed as the reason for this [4] [14]. Some of the other reported side effects are excitement, nervousness, and hyperpigmentation [6].

There is a report indicating sertraline-induced exacerbation of tics in Tourette's syndrome [7]. However, there is just one case report on the emergence of tics associated with escitalopram and sertraline treatment [1] in which the patient, who was suffering from panic disorder, experienced involuntary, paroxysmal contractions of the muscles around her right eye and forehead eight weeks after starting escitalopram. Escitalopram was then replaced with sertraline after about 2 months. Tics were re-experienced three weeks after the initiation of sertraline. As the patient was taking alprazolam in addition to escitalopram in the course of the treatment, this may of course have been a contributing factor [1].

Co-morbidity of obsessive compulsive disorder with tic disorders is commonly cited as a poor prognostic factor for both medication and CBT [10]. Tic disorders have been supposed as a reason for neuroleptic augmentation of treatment with a serotonin reuptake inhibitor [12]. SSRIs are not an effective treatments for tics [13]. The induction of tics with antidepressant treatment may have an effect on the selection of the subsequent antidepressant.

This report concerns a patient who experienced tics while she was taking sertraline.

References

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