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To: Journal of PRACTICAL NEUROLOGY Letters

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Short reports: M Brandt-Christensen, K Kvist, F M Nilsson, P K Andersen, and L V Kessing Treatment with antidepressants and lithium is associated with increased risk of treatment with antiparkinson drugs: a pharmacoepidemiological study J Neurol Neurosurg Psychiatry 2006; 77: 781-783 [Abstract] [Full text] [PDF]

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An alternative explanation for increased antiparkinson medications with lithium or antidepressants

Joseph H Friedman, none   (23 May 2006)

An alternative explanation for increased antiparkinson medications with lithium or antidepressants 23 May 2006
Joseph H Friedman, Neurologist NeuroHealth; Brown Medical School, none Send letter to journal: Re: An alternative explanation for increased antiparkinson medications with lithium or antidepressants Joseph_Friedman{at}brown.edu Joseph H Friedman, et al.	Dear Editor, This very interesting report may well be correct in suggesting an association between mood disorders in general (not just depression) and Parkinson's disease (PD). However a more likely consideration, given the observation that the anti-PD medications were mostly begun within the first six months of starting the mood-treatment drugs, is that the parkinsonian syndrome was drug induced. Lithium and the selective serotonin reuptake inhibitors have been associated with parkinsonism (1- 5)and it is likely that some patients receiving lithium were also taking valproic acid, another drug associated with parkinsonism(1). My own experience has been that lithium induced parkinsonism is underrecognized, but I have no data to support that contention. Unfortunately the data available for analysis from this study will not be able to distinguish drug induced parkinsonism from idiopathic PD but this problem confounds the interpretation provided. References 1. Nguyen N, Pradel V, Micallef J, et al. Drug-induced parkinson syndromes. Therapie 2004;59:105-112. 2. Holroyd S, Smith D. Disabling parkinsonism due to lithium: a case report. J Geriatr Psychiatry Neurol 1995;8:118-119. 3. Shopsin B, Gershon S. Congwheel rigidity related to lithium maintenance. m J Psychiatry 1975;132:536-538. 4. Lecamwasam D, Synek B, Moyles K, et al. Chronic litium neurotoxicity presenting as Parkinson's disease. Int Clin Psychopharmacol 1994;9:127- 129. 5. Caley C. Extrapyramidal reactions and the selective serotonin-reuptake inhibitors. Ann Pharmacother 1997;31:1481-1489.