Pediatrik Bir Hastada Fluoksetin Kaynaklı Diskinezi: Polifarmasi ve Serotonerjik Düzenlemenin Etkileri Üzerine Bir Vaka Raporu ve Literatür İncelemesi

Year 2025, Volume: 27 Issue: 2, 214 - 218, 30.08.2025

Cansel Azizağaoğlu , Esra Doğan Elmas , Şahin Bodur , Mehmet Ayhan Cöngöloğlu

https://doi.org/10.18678/dtfd.1588227

Abstract

Psikiyatrik ilaçlara bağlı hareket bozuklukları, çoğunlukla antipsikotik ilaçlar olan dopamin reseptör bloke edici ilaçların yan etkileriyle ilgilidir. Bu yan etkiler, akut distonik reaksiyonlar, akatizi, diskinezi, nöroleptik malign sendrom, parkinsonizm ve çeşitli tardif sendromlara neden olabilir. Diskinetik hareketler, ekstremitelerin, yüz ve perioral kaslarının hiperkinetik, tekrarlayan hareketleri ile karakterize edilir. Nadir durumlarda dolaylı bir D2 blokaj mekanizması yoluyla selektif serotonin gerialım inhibitörleri (selective serotonin reuptake inhibitors, SSRIs) kullanımı sonucu diskinetik hareketler ortaya çıkabilir. Bu olgu sunumunda, metilfenidat ve risperidon kullanan bir hastada fluoksetin doz artışı sonrasında görülen diskinezi sunulmuştur. SSRI’nın, dopamin reseptör antagonizması ile dopamin aktivitesini inhibe ettiği ve SSRI’ların CYP450 metabolizmasını inhibe ederek risperidon konsantrasyonunda bir artışa neden olabileceği düşünülmüştür. Literatürde SSRI kaynaklı diskinezi vakaları az sayıdadır, bu alanda kısıtlı bilgi mevcuttur. Bu olgu sunumu, SSRI’ların potansiyel diskinezi yan etkisine dikkat çekmektedir.

Keywords

Diskinezi , ekstrapiramidal yan etkiler , dopamin reseptör blokerleri , fluoksetin

Fluoxetine-Induced Dyskinesia in a Pediatric Patient: A Case Report and Literature Review on Implications of Polypharmacy and Serotonergic Regulation

Abstract

Movement disorders associated with psychiatric medications are primarily related to the side effects of dopamine receptor-blocking drugs, which are mostly antipsychotic medications. These side effects are acute dystonic reactions, akathisia, dyskinesia, neuroleptic malignant syndrome, parkinsonism, and various tardive syndromes. Dyskinetic movements are characterized by hyperkinetic, repetitive movements of the extremities, facial, and perioral muscles. In rare cases, dyskinetic movements may occur with the use of selective serotonin reuptake inhibitors (SSRIs) through an indirect D2 blocking mechanism. In this case report, dyskinesia observed after increasing the dose of fluoxetine in a patient using methylphenidate and risperidone was presented. It was thought that the SSRI inhibited dopamine activity through dopamine receptor antagonism and that SSRIs may increase risperidone concentrations by inhibiting CYP450 metabolism. There are few cases reported in the literature regarding SSRI-induced dyskinesia, information is limited on this subject. This case report highlights the potential dyskinesia side effect of SSRIs.

Keywords

Dyskinesia , extrapyramidal side effects , dopamine receptor blockers , fluoxetine

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