PANES case 3 - 8 months after withdrawal she still had myoclonic jerks

Mrs C., a 29-year-old mother of one, became ill with depression when her son was aged eight months. She was suicidal and required hospital admission where she was started on fluoxetine 20 mg daily. The antidepressant worked well and her mood was restored within four weeks of admission. She was discharged home, but commented that her sleep was occasionally disturbed by bad dreams and she was aware of twitching in the bed. She was kept on the fluoxetine for a further twelve months and at outpatient reviews mentioned that her sleep was still occasionally disturbed by nocturnal twitching. She said that her husband had started to sleep separately, because he was 'tired of being kicked' in the middle of the night. The fluoxetine was discontinued eighteen months after the admission. Mrs C described no worsening of her mood and was euthymic and outpatient review. However, she was distressed to report that her nocturnal twitching, which took the form of sudden myoclonic jerks of her limbs, had actually worsened off fluoxetine. During the day these abnormal involuntary movements were less marked and more easily disguised, but nonetheless problematic for the patient. At follow-up eight months after discontinuation the untoward myoclonic jerks were continuing. There are no focal neurological signs or any features suggestive of progressive neurological disease, nor was there a family history of neurological disease.