Dystonia and activation

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dontspeak

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Curious to know which ssri/snri medication could be suitable for a patient that has developed dystonia ( of the tongue, upper lip) from the use of amitritpyline and thorazine. There is no psychosis, mania/schizophrenia or personality disorders present, however there is mixed depression and anxiety. The patient is wary of the side effects and reluctant to try any medication that would make this worse.

Are there any particular ssri's / snri's that have a good track record for not inducing this symptom?

Thanks
 
Curious to know which ssri/snri medication could be suitable for a patient that has developed dystonia ( of the tongue, upper lip) from the use of amitritpyline and thorazine. There is no psychosis, mania/schizophrenia or personality disorders present, however there is mixed depression and anxiety. The patient is wary of the side effects and reluctant to try any medication that would make this worse.

Are there any particular ssri's / snri's that have a good track record for not inducing this symptom?

Thanks

First, do you mean dyskinesia (involuntary movement) or dystonia (involuntary muscle contraction)? Second, why was the pt on thorazine in the first place with no psychosis or mania?

To answer your question, the only antidepressant that I can think of that would exacerbate TD or EPS would be amoxapine because a metabolite is the antipsychotic loxapine. So IMO pretty much any SSRI/SNRI should be fine.
 
First, do you mean dyskinesia (involuntary movement) or dystonia (involuntary muscle contraction)? Second, why was the pt on thorazine in the first place with no psychosis or mania?

To answer your question, the only antidepressant that I can think of that would exacerbate TD or EPS would be amoxapine because a metabolite is the antipsychotic loxapine. So IMO pretty much any SSRI/SNRI should be fine.

It is the first presentation so i assume it is dystonia, as the movements are not side to side, just contraction based at this stage. The thorazine use has been exceedingly low (close to 20 tablets) at 25mg dosage which is what makes the symptoms of the tongue and upper lip movements so interesting. The patient is on thorazine for progressive/persistent headaches with nausea that may be exacerbated by anxiety/depression.
The professor has explained that thorazine is an acceptable treatment for leveling out these symptoms, but obviously not now at the cost of a dystonia or movement disorder.
I am just curious as the patient is sensitive to such a small amout of thorazine (dopamine upregulation due to very short term use) then perhaps the patient may also display these symptoms if placed on an ssri/snri medication due to the reverse of the current situation, because of a decrease in dopamine. I was thinking this due to the push pull effect of serotonin on dopamine. My understanding of this mechanism is not very complex.
 
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Sorry to intrude, not being a Doctor and all, but didn't you just ask for advice for yourself related to irretractable headaches, and subsequent anxiety and depression? And weren't you just told for legal/ethical reasons the Doctors on this forum couldn't dispense medical advice? If you're having side effects from your medication that are concerning to you, then the person you should be speaking to is your prescribing Doctor, not a bunch of people on an internet forum. Seriously, you could get someone into a lot of trouble with this.
 
Sorry to intrude, not being a Doctor and all, but didn't you just ask for advice for yourself related to irretractable headaches, and subsequent anxiety and depression? And weren't you just told for legal/ethical reasons the Doctors on this forum couldn't dispense medical advice? If you're having side effects from your medication that are concerning to you, then the person you should be speaking to is your prescribing Doctor, not a bunch of people on an internet forum. Seriously, you could get someone into a lot of trouble with this.

Yes i was told this in a previous post, however this post is in no relation to th is of no relevance to me. I do have headaches that are treated with inderal.
The post is to gain a better understanding of drug mechanisms, not for any other reason

The scenario explained above is one which a lecturer in my pharmacology class brought up and i further discussed it with him
 
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