Focus On Depression In Parkinsons Disease: A Delphi Consensus Of Experts In Psychiatry Neurology And Geriatrics
Luis Agüera-Ortiz
1Servicio de Psiquiatría, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
2Centro de Investigacio?n Biome?dica en Red de Salud Mental , Madrid, Spain
3Movement Disorders Unit, Servicio de Neurología, Hospital Clínico San Carlos, Complutense University, Madrid, Spain
4Movement Disorders Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
5Service of Psychiatry, University Hospital Ramón y Cajal. CIBERSAM, IRYCIS. University of Alcalá, Madrid, Spain
6Service of Neurology, HGU Gregorio Marañón, Madrid, Spain
7Memory Disorders Unit, HM Hospitales, Madrid, Spain
8Service of Psychiatry, Hospital Universitario “San Jorge”, Huesca, Spain
9Neurological Rehabilitation Unit, Clínica Ubarmin, Pamplona, Navarra, Spain
10Service of Neurology, Instituto de Neurociencias, Hospital Clínico San Carlos, San Carlos, IdISSC, Madrid, Spain
Abstract
1. Introduction
Neuropsychiatric disorders such as depression very often accompany core motor impairments of Parkinson’s disease . More and more, they are perceived as significant contributors to PD morbidity and caregiver burden as they have a major impact on patient’s function, quality of life, and long-term outcomes. In fact, it has been suggested that PD should be classified as a neuropsychiatric disease itself rather than a movement disorder .
2. Materials and Methods
2.1. Study Design
2.2. Participants
2.3. Delphi Methodology
2.4. Statistical Analysis
3. Results
What Is The Difference Between Drug Induced Parkinsons Disease And Typically Occurring Parkinsons Disease
It has been seen that drug-induced Parkinsonism usually occur on both sides of your body while usual Parkinson’s starts from one side of the body. Apart from this, the medication-induced signs generally are seen to go away after the medicine is finished. However, it may take few months to stop, but is does stop eventually. On the contrary, the typically occurring Parkinson’s disease cannot be reversed. Another thing to be kept in mind is that medication-induced Parkinson’s disease is not progressive, unlike the typical Parkinson’s disease.
Comparative Efficacy And Acceptability Of Antidepressants In Parkinson’s Disease: A Network Meta
- Jinling Liu ,
Contributed equally to this work with: Jinling Liu, Jiangchuan Dong
Affiliation Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Contributed equally to this work with: Jinling Liu, Jiangchuan Dong
Affiliation Department of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, China
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Affiliation Department of Neurology, Weifang People’s Hospital, Weifang, Shandong, China
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* E-mail:suying0110@126.com
Affiliation Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Affiliation Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Affiliation Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
Is Your Medication Making You Sweat 10 Drugs That Cause Excessive Sweating As A Side Effect Sharon Orrange, MD, MPH
If you’ve noticed you are sweating more than usual — not just on your palms and soles, but all over — take a look at your medication list. The new occurrence of excess sweating everywhere on your body can be a result of many causes including diabetes, thyroid disease, and infection, so it requires a careful evaluation by your healthcare provider. But medications are a common offender.
It turns out, the human sweating response is influenced by a number of drugs. Most times this is normal, but other times it can be a sign of something more serious. Here are some common medications that have a sweaty side, and why.
Serotonin Reuptake Blocking Antidepressants Fluoxetine Sertraline And Paroxetine
Several other medications have been reported to cause drug-induced parkinsonism and to worsen parkinsonism in people with Parkinson disease, including the serotonin reuptake blocking antidepressants fluoxetine, sertraline, and paroxetine. Two calcium channel blockers available in Europe and South America , which are piperazine derivatives, are thought to cause drug-induced parkinsonism by blocking dopamine receptors. Reports of parkinsonism induced by other drugs, such as lithium and amiodarone, are so rare that only after parkinsonism has developed should the possible drug effect be taken into account. Because lithium is not known to block dopamine receptors, another mechanism is likely. Some animal data implicate an effect of lithium on intercellular signalling via G-protein coupled receptors . One antidepressant, amoxapine, has dopamine receptor-blocking properties and, therefore, may induce parkinsonism. Parkinsonism as a transient side effect of alcohol withdrawal has been reported without later development of Parkinson disease, but it is unknown how common this is .
Any Medication That Blocks Dopamine In The Body Can Cause Parkinsons Symptoms
You may have heard of Parkinson’s disease , a movement disorder. Someone with it may have characteristic signs, such as a pill-rolling tremor in the fingers or a hunched forward posture. You may recognize someone with this disease from the faltering, tiny steps they take when they walk or by their rigidly emotionless face.
The cause of Parkinson’s disease is mostly unknown. Some people develop Parkinson’s-like symptoms after treatment with certain medications. This is called drug-induced parkinsonism or secondary parkinsonism. Certain medications can also worsen symptoms in someone who already has Parkinson’s disease.
Any medication that blocks dopamine in the body can cause Parkinson’s symptoms. Dopamine is a brain chemical that helps control movement. Common dopamine-blocking drugs are antipsychotics. They are used to treat certain mental illnesses or severe nausea. Less commonly, certain types of calcium channel blockers cause drug-induced parkinsonism. These drugs may be used to treat chest pain and high blood pressure, or irregular heart rate.
Parkinsons Risk Linked To Cymbalta Celexa Similar Antidepressants: Study
- July 12, 2018
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New research suggests that the side effects of some antidepressants, such as Zoloft, Celexa and Cymbalta, may increase the risk of Parkinson’s disease.
In a study published in the August 2018 edition of the Journal of Clinical Psychopharmacology, researchers from the University of British Columbia say there appears to be a link between a number of popular antidepressants, Parkinson’s disease and extrapyramidal symptoms .
According to the findings, the associations were found with the use of Celexa, Cymbalta, Remeron, Lexapro, Paxil, Zoloft, Effexor, Zyban, Wellbutrin, and Prozac.
“Antidepressants are one of the most prescribed classes of medications. A number of case reports have linked these drugs to extrapyramidal symptoms , but no large epidemiologic study to date has examined this association,” the researchers noted. “We sought to quantify the association of EPSs with different antidepressants by undertaking a large pharmacoepidemiologic study.”
Researchers conducted a nested case-control study using data from June 2006 through December 2015, collected by a large claims database in the U.S. They found 3,838 subjects with EPSs and compared them to 38,380 age-matched control subjects.
The effect was not seen throughout all antidepressants, however. Atamet, Requip, Mirapex and a number of others showed no significant association.
What Are The Other Forms Of Medicines That Can Cause Parkinsons Disease
Some of the other common medicines which can cause Parkinson’s disease may include some forms of anti-depressants, anti-nausea drugs, drugs used for the treatment of vertigo, drugs used for epilepsy and anti-arrhythmics. It should be remembered that not all drugs in these classes may cause signs of Parkinsonism. The doctor generally makes the patient aware of the side-effects before prescribing a certain form of drugs. Nevertheless, it is important from the patient’s part to ask about the side-effects of the prescribed medicines.
Are Older Antidepressants Better For Depression In Parkinsons Disease
The American Academy of Neurology, an association of more than 21,000 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as stroke, Alzheimer’s disease, epilepsy, Parkinson’s disease, and multiple sclerosis.For more information about the American Academy of Neurology, visit www.aan.com.
Not All Drugs In These Classes Will Cause Symptoms Of Parkinsonism
What’s the difference?
Drug-induced parkinsonism usually develops on both sides of the body, while typical Parkinson’s disease does not. Also, drug-induced parkinsonism usually does not progress like typical Parkinson’s.
Unlike Parkinson’s, drug-induced symptoms usually go away after the drug is stopped. It may take several months, though, for the symptoms to completely stop. If the symptoms remain, then it is possible that the drug may have “unmasked” underlying Parkinson’s disease.
Who is at risk?
- Female: Women are twice as much at risk as men.
- Elderly: Older people are more likely to be on multiple medications or to have underlying Parkinson’s disease.
- Those with a family history of Parkinson’s disease.
- People with AIDS.
Difficulties In Diagnosing Depression In Patients With Parkinson’s
- Certain symptoms of depression overlap with symptoms of PD ? for example, sleep problems and feeling slowed down occur in both conditions.
- Some experts think that depression in PD often involves frequent, shorter changes in mood versus a constant state of sadness daily.
- Many people with PD express less emotion due to the effect the disease has on the muscles of the face. This symptom, called facial masking, makes a person unable to express emotion through facial expressions.
- Many people with Parkinson’s do not seek treatment because they often do not recognize they have a mood problem or are unable to explain symptoms. For these reasons, it is helpful to ask a caregiver or loved one if he or she has noticed any changes commonly reported in depression.
How Is Depression Treated In People With Parkinsons Disease
Depression must be treated differently in people who have Parkinson’s disease. Many people can be treated with a type of antidepressant called serotonin reuptake inhibitors . However, some other Parkinson’s symptoms may worsen from SSRI use in a very small number of people.
SSRIs shouldn’t be taken if you’re currently taking selegiline . This is a commonly prescribed medication to control other symptoms of Parkinson’s.
If both are taken at once, it could cause serotonin syndrome. Serotonin syndrome occurs when there’s excessive nerve cell activity, and it can be fatal. Symptoms can include:
- confusion, disorientation, or hallucinations
- digestive issues like diarrhea or nausea
- rapid heartbeat, or tachycardia
- overactive reflexes, or hyperreflexia
- dilated pupils
Some medications used to treat other symptoms of Parkinson’s, like dopamine agonists, may have an antidepressant effect. These appear to be particularly helpful in those who experience periods when their medication isn’t effective. This is also known as “on-off” motor fluctuation.
Treating Depression In Parkinson’s Disease: Study Results
Patients in all three treatment groups, including the placebo group, showed improvement on a commonly used scale to gauge depression known as the Hamilton Rating Scale.
Those on antidepressants improved more than did those on placebo, Richard says.
On average, those getting Paxil had a 59% improvement. Those taking Effexor had a 52% improvement. Those who got the placebo had a 32% improvement.
Richard evaluated their depression using three other scales and found similar results.
There was no effect on movement ability.
Richard can’t say which antidepressant type is better for treating depression in Parkinson’s disease, she says. The study did not do a head-to-head comparison of the two types.
Each type, SSRI and SNRI, includes many different medicines, so patients have a choice, she says.
Both medicines studied are available as generics, Richard says. At the doses studied, the cost would be about $20 to $30 a month.
Patients reported side effects such as insomnia, constipation, sexual dysfunction, and fatigue. Three patients, including one in the placebo group, had serious side effects. These included chest pressure, bowel obstruction, and heart rhythm problems.
However, only the patient with heart rhythm problems withdrew.
Wyeth Pharmaceuticals provided the venlafaxine XR. Glaxo SmithKline provided the paroxetine.
Who Are At Risk Of Developing Drug Included Parkinsonism
Some patients may be at a higher risk of developing medication-induced Parkinson
ism than others. Some of the risks include-
Women: Women are seen to be two times as much at risk of having drug inducing Parkinson’s disease than men.
AIDS Patients: People with AIDS are at a higher risk.
Family History: Patients having a family history Parkinson’s disease are at a higher risk of having drug induced Parkinsonism.
Elderly: Since elder people are usually on multiple medicines, they are at risk of having drug induced Parkinsonism.
Treating Depression In Parkinson’s Disease: Perspective
The study has ”critical information” for patients and caregivers, says Michael S. Okun, MD, national medical director of the National Parkinson Foundation. He reviewed the findings.
“The bottom-line message is that treatment for depression in Parkinson’s disease matters,” he says. “An important aspect of this particular study was that it had a placebo group, and that the investigators showed that either antidepressant performed better than placebo for Parkinson patients.”
An editorial that accompanies the study concludes that depression in Parkinson’s patients may be as treatable as it is in the general population.
Cholinesterase Inhibitors Widely Used To Treat Dementia
Cholinesterase inhibitors, widely used to treat dementia, may cause worsened parkinsonism, primarily increased tremor . Large double-blind trials of rivastigmine, a cholinesterase-inhibiting drug, in both dementia with Lewy bodies and Parkinson disease dementia have demonstrated that rivastigmine is well tolerated without significant worsening of motor function overall, although tremor may increase . The other cholinesterase inhibitors have been less well studied but appear to have similar benefits and side effects.
Atypical Parkinsonism Or ‘parkinson’s Plus Syndromes’
“Parkinson’s Plus Syndromes” are less common than Parkinson’s disease.
Some atypical parkinsonism syndromes include:
Multiple system atrophy This is a category of several disorders in which one or more body systems deteriorate.
Your doctor may classify you as having MSA-P, in which parkinsonian symptoms are dominant; or MSA-C, in which dysfunction of the cerebellum is dominant.
The names of some of these syndromes include olivopontocerebellar atrophy , Shy-Drager syndrome , and striatonigral degeneration .
Progressive supranuclear palsy Symptoms of this condition usually begin after age 50 and proceed more rapidly than Parkinson’s disease.
In people with PSP, problems with eye movement can lead to blurry vision. Falls tend to occur early in the course of the disease, and dementia may occur later in the disease.
Corticobasal degeneration This condition may cause jerking and loss of control in a limb, often without weakness in that limb.
If you have this disorder, you may be given Botox to help your limb relax.
Lewy body dementia LBD is the second leading cause of dementia in the elderly, after Alzheimer’s disease.
In this condition, the same Lewy bodies occur in the brain as in Parkinson’s disease, but in multiple areas of the brain.
If you have LBD, you may experience speech problems, hallucinations, and gradual cognitive decline.
Tremor As A Side Effect From Taking Antidepressants
Is it normal to develop a tremor while taking an antidepressant? Which drugs may cause this symptom and how is it treated? Learn more about what a tremor is, the different types of tremors, and what other medications as well as medical conditions which may contribute to a tremor.
What Causes Shaky Hands It Could Be Your Medication Sharon Orrange, MD, MPH
My hands are shaking. Is it Parkinson’s? Something else? Shakiness, or tremors, is a common problem that brings patients to my office. If you start having shaky hands, you may worry that you have Parkinson’s disease, but many other things can cause tremors—like medications. The good news is, drug-induced tremors go away with lower doses or if you stop taking the medication.
Antidepressants Aid Depressed Parkinson’s Patients
Two Classes of Medicine Help Depression in People With Parkinson’s Without Worsening Other Symptoms, Experts Say
April 11, 2012 — Certain antidepressantmedications can help treat depression in people with Parkinson’s disease without making the symptoms of the disease worse, according to a new study.
Researchers looked at two common types of antidepressant medicines in the study. They found that both improved depression.
There has been a lingering suspicion that antidepressants may make the symptoms of Parkinson’s worse, but this study may help set aside some of those fears.
“We showed that we have effective and well-tolerated treatments for depression in Parkinson’s,” says researcher Irene Hegeman Richard, MD, associate professor of neurology and psychiatry at the University of Rochester Medical Center.
“Depression is the thing that most impacts quality of life,” she says. “It’s present in almost 50% of patients.”
About a million people in the U.S. have the brain disorder, according to the National Parkinson’s Foundation. It leads to shaking or tremors and difficulty with walking, movement, or coordination.
The study is published in the journal Neurology. It was funded by the National Institutes of Health/National Institute of Neurological Disorders and Stroke and Johns Hopkins University School of Medicine.
Hospitalization Due To All Cardiovascular Events
The propensity score-adjusted model suggested that there was no significant difference between patients who used antidepressants and non-users in terms of developing cardiovascular events, specifically arrhythmia, heart failure, IHD, stroke, or cardiovascular death . Non-significant associations with all cardiovascular events were also reported among different antidepressant categories and individual drugs .
Parkinsonism Due To Other Neurological Disorders
The following neurological disorders are known to cause parkinsonian symptoms:
Vascular parkinsonism Also known as arteriosclerotic parkinsonism, this condition is caused by multiple small strokes.
The onset of symptoms can be sudden or gradual, and often includes mobility problems in your legs. Symptoms may level off for a period of time.
Vascular parkinsonism has the slowest rate of progression of all atypical parkinsonisms. It doesn’t usually cause tremors, either.
Post-traumatic parkinsonism Also known as post-traumatic encephalopathy or “punch-drunk syndrome,” this condition may be caused by a severe head injury or by frequent head trauma, such as from boxing or football.
Post-traumatic parkinsonism can lead to a type of dementia called chronic traumatic encephalopathy . In March 2016, the National Football League admitted that there might be a link between CTE and head trauma.
Essential tremor This is a tremor that tends to run in families and become worse over time. It’s usually seen most severely in the hands, especially when the hands are moving.
Normal pressure hydrocephalus This condition is caused by an abnormal increase in fluid in the cavities of the brain.
NPH can sometimes be treated by draining the extra fluid into your abdomen using a shunt.
Environmentally Caused Parkinsonism
The following disorders are caused by outside factors like drugs and infection:
The following substances can cause drug-induced parkinsonism:
Treatment For Tremors Caused By Antidepressants
Perhaps the best solution for tremors caused by antidepressants is to stop taking the drug causing it and switch to a different medication. Tremor will generally resolve over time after the medication has been ceased, but occasionally a tremor caused by SSRIs may persist.
Sometimes, however, you may be doing so well on your medication that you don’t want to change it for fear of returning depression. If this is the case, your doctor may opt to add an additional medication to control your tremors. Some medications that may be used to manage antidepressant-induced tremors include:
- Beta-blockers
Morgan JC, Kurek JA, Davis JL, Sethi KD. Insights into pathophysiology from medication-induced tremor. Tremor Other Hyperkinet Mov . 2017;7:442. Published 2017 Nov 22. doi:10.7916/D8FJ2V9Q
Dixit, S., Khan, S., and S. Azad. A Case of SSRI Induced Irreversible Parkinsonism. Journal of Clinical and Diagnostic Research. 2015. 9:VD01-VD02. doi:10.7860/JCDR/2015/11394.5583
National Institutes of Neurological Disorders and Stroke. Tremor Fact Sheet. Updated August 13, 2019.
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Kasper, Dennis L.., Anthony S. Fauci, and Stephen L.. Hauser. Harrison’s Principles of Internal Medicine. New York: Mc Graw Hill education, 2015. Print.
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U.S. National Library of Medicine. Medline Plus. Drug-Induced Tremor. Updated 09/05/17.
Immunosuppressants: Cyclosporine And Tacrolimus
Cyclosporine and tacrolimus are immunosuppressants used in patients who have received transplants as well as those with autoimmune diseases. Up to 40% of folks taking cyclosporine may experience tremor since it interferes with dopamine receptors. Tacrolimus also causes tremors, classically of the hands.
Pro-tip: Long-acting tacrolimus, Envarsus XR, does not tend to cause the same tremor.
Longtime Antidepressant Could Slow Parkinson’s
- Date:
- Michigan State University
- Summary:
- Scientists now have early proof that an antidepressant drug that’s been around for more than 50 years could slow the progression of Parkinson’s.
Michigan State University scientists now have early proof that an antidepressant drug that’s been around for more than 50 years could slow the progression of Parkinson’s.
In a proof-of-concept study, published in the journal Neurobiology of Disease, the drug nortriptyline, which has been used to treat depression and nerve pain, stopped the growth of abnormal proteins that can build up in the brain and lead to the development of the disease.
“Depression is a very frequent condition associated with Parkinson’s, so we became interested in whether an antidepressant could modify how the disease progresses,” said Tim Collier, lead author of the federally funded study and a neuroscientist at MSU.
Collier and collaborator Katrina Paumier, an assistant professor of molecular medicine, began looking at previous patient data to see if individuals who were on antidepressants experienced any delay in their need to go on a standard Parkinson’s therapy called levodopa. This type of therapy increases levels of dopamine, a natural chemical in the body that sends signals to other nerve cells and can significantly decrease in cases of Parkinson’s.
The medication also treats many of the symptoms associated with the disease such as tremors and poor muscle control.
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What Are The Treatment Options For Depression
Just as the symptoms and causes of depression can differ from person to person, so too can suitable treatment approaches. There are two main types of treatment options for depression: antidepressant medications and psychological counseling .
The Parkinson’s Foundation recommends a holistic, comprehensive approach to depression. Although antidepressants are often effective in reducing symptoms, they should seldom be used alone. In most cases, the best approach is a combination of antidepressant medication, counseling, exercise and social support.
How can you ease depression in PD? First, share your concerns with your doctor. Many movement disorders specialists now include questions about depression in their exams. If your doctor does not, raise the topic. He or she may recommend medical or nonmedical coping strategies, including the following:
Signs A Medication May Be Causing Your Tremor
Medications can both cause tremors and make them worse. Think about whether your medication is the cause of your shakiness if:
- You don’t have other conditions like low blood sugar or hyperthyroidism that cause shakiness.
- Your hands started shaking when you started taking the medication.
- You noticed the tremor when you increased the dose of your medication.
- The tremor isn’t worsening—but it’s staying the same.
- The tremor looks the same on both sides .
Albuterol Salmeterol And Formoterol Inhalers
Albuterol, salmeterol and formoterol inhalers contain beta-agonist medications used for asthma and other respiratory conditions. Brands include Ventolin, Proair, Proventil, Serevent and Brovana. These drugs are best-known for causing medication-induced tremors. They activate the body’s “fight or flight” response, increasing levels of stress hormones epinephrine and norepinephrine, which work directly on the muscle.
Fda Alerts For Popular Antidepressant Drugs
Today, the most popular drugs used for depression treatment in both children and adults is SSRI. Although most physicians trust the medications due to fewer side effects, they are not 100% safe for all users. Some of the common SSRI prescriptions include:
- Paxil
- Lexapro
- Zoloft
Patients who take these drugs coupled with some triptans, drug treatment for migraine, may have potentially fatal serotonin syndrome. It can cause symptoms such as muscle cramps, high blood pressure, and confusion. If the syndrome becomes life-threatening, the patient may also experience high fevers, seizures, and consciousness loss.
Treating Depression In Parkinson’s Disease
Depression in people with Parkinson’s is still under-recognized and under-treated, Richard tells WebMD.
As doctors have become more aware of how common it is, she says, they have struggled with how best to treat it.
Older antidepressants known as tricyclic antidepressants are sometimes used, she says. But their use is linked with certain types of heart problems and other side effects.
Richard’s team studied paroxetine and venlafaxine extended release , comparing it to placebo.
Paroxetine is an SSRI , which affects levels of the hormone serotonin in the brain, improving mood.
Venlafaxine extended release is an SNRI . It works by balancing the two hormones to improve mood.
The 115 patients all had both Parkinson’s and clinical depression. Patients had to be at least 30 years old and free of dementia. They were treated at 20 different centers in the U.S., Canada, and Puerto Rico from June 2005 through March 2009.
The patients were assigned to one of three groups: paroxetine, venlafaxine, or placebo.
The patients took a maximum of 40 milligrams of paroxetine or 225 mg of venlafaxine daily.
The researchers evaluated their depression at the start and throughout the 12-week study. They looked to see if the treatment affected their movement ability.
Can Drug Induced Parkinsonism Be Prevented
Although there is no surety in the prevention of drug-induced parkinson’s disease, but efforts may be made to check the dosage of drugs so prescribed-
Be Cautious with Antipsychotics: The patient or in some cases the caregiver should make sure that antipsychotic drugs are given at their least effective dosage.
Inform the Doctor: The doctor should be informed well before in case the patient already has symptoms of Parkinson’s disease so that they do not appear to get worse with the starting of some prescribed drugs.
Abrupt Stoppage of Medicine: It is never a wise decision to stop taking a medicine by oneself. It is important to talk to the doctor in case of any concerns.
What To Do If Your Senior Has Parkinsons
If you notice Parkinson’s-like symptoms in your older adult, the first thing to do is talk with their doctor. The doctor should review their complete medication history and you should let them know about any other symptoms or changes.
Important: Don’t make any changes to medications without doctor approval – that could cause serious problems.
What Drugs Can Cause Parkinsons Disease
Physiologically, Parkinson’s disease is caused due to low levels of dopamine secretion in the body. Thus, any medication that blocks the level of dopamine in the body and cause Parkinson’s symptoms. Dopamine is a brain chemical that essentially helps control movement of a person. The various drugs include-
Antipsychotic Drugs- Parkinson symptoms are seen to be common in patients who are prescribed antipsychotic drugs. Parkinsonism as a side effect of chlorpromazine is quite common. Typical antipsychotic drugs include chlorpromazine, promazine, haloperidol, perphenazine, fluphenazine and pimozide. Dopamine receptors are widely distributed in the brain and typical antipsychotics may affect dopamine receptors in the striatum.
GI Motility Drugs- GI prokinetic drugs like metoclopramide, levosulpiride, clebopride, itopride and domperdone may cause side effects thereby making the patient prone to Parkinsonism.
Antipsychotic Drugs Called Neuroleptics
Drug-induced parkinsonism is due primarily to drugs that block dopamine receptors, particularly the D2 receptors . These drugs are most often the antipsychotic drugs, called neuroleptics, such as haloperidol, chlorpromazine, and trifluoperazine, but include metoclopramide, a gastrointestinal motility enhancer, and the antiemetics prochlorperazine and droperidol. In addition, medications that block synthesis of dopamine, such as alpha-methyl para-tyrosine and alpha-methyl dopa or deplete dopamine also induce parkinsonism. In these cases the pathophysiology is presumably due to diminished dopamine receptor stimulation, resulting in a pharmacologic state closely resembling Parkinson disease.
However, the atypical antipsychotics also block D2 receptors. Yet there is no apparent correlation between the degree of this blockade and the risk for inducing parkinsonism. The explanation for this is uncertain. One current hypothesis is the “fast off” theory, postulating that the duration of the D2 blockade, rather than the percentage of receptors blocked, determines the likelihood of parkinsonism . A competing theory is that the ratio of 5 HT-2a receptor blockade versus the dopamine D2 receptor blockade is critical because of the interplay between the serotonin and dopamine systems in the brain. An older theory relating extrapyramidal side effects to anticholinergic activity is considered untenable because the concomitant use of anticholinergics does not eliminate the problem.
When To Be Suspicious Of Medications
In many cases, symptoms of Parkinson’s could be caused by a new medication that was started a few days or a few months ago.
In other cases, it could be caused by medications that start out at one dose and are increased to higher doses. If the dose increases move too quickly, that can also cause these symptoms.
Other factors also make it more likely that someone will develop Parkinson’s symptoms from medications. These include having a history of:
- Dementia
- Strokes or transient ischemic attacks
- Parkinson’s in the family
Other Medications That Cause Tremors
Other psychiatric medications—such as lithium and Depakote —may also commonly cause tremor.?? Antipsychotic medications, particularly the older agents , may cause a tremor similar to Parkinson’s disease.
Extrapyramidal side effects of these drugs may also include dystonia , tardive dyskinesia , and akathisia, a feeling of restlessness which may sometimes mimic a tremor.??
In addition, there are a wide variety of other prescription drugs which may cause tremor. These include:
- Anticonvulsants
- Some heart and blood pressure medications
- Stimulants such as caffeine and amphetamines
Can Antidepressants Cause Psychosis
Psychreg on Clinical Psychology
Antidepressants are used as a medication for patients suffering from depression or dysthymic disorder. However, it’s worth noting that the medicines are meant to lessen their symptoms but not completely cure them. While using the medication, you also need to be vigilant of any adverse side effects.
There have been lots of reports where people on antidepressants suffered from severe side effects like psychotic episodes. Research conducted by giving SSRIs to 2,200 children showed that 4% of them experienced suicidal thoughts. This led to a Black box warning by the FDA on various prescription drugs. Read on to learn more.