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Monday, 30 November 2009

PANES case 1 - just like Bob she was on dothiepin, then on to Seroxat - withdrawal due to dystonic reaction - 7 months later she still had dystonia

Mrs A. a 29 year old married lady with a moderate depressive disorder was switched to paroxetine by her general practitioner after an initial prescription of dothiepin. She had found the tricyclic dothiepin too sedating and after a week or so of this medication requested a change. After two weeks on paroxetine 20 mg daily she was reviewed by a consultant psychiatrist who increased the dose to 40 mg daily. The patient suffered a dystonic reaction to the paroxetine that required physician review and admission, but apparently responded well to procyclidine. The paroxetine was discontinued. Unfortunately the dystonic reaction persisted off all medication and required further medical admission and the re-prescription of procyclidine. The depression continued unabated and a tricyclic was started with some improvement in mood. Seven months after the paroxetine had been stopped the tardive dystonia was noted to be present and to vary with anxiety levels, body posture, alertness, and emotional state.

http://priory.com/psych/panes.htm#Case1

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