Title:Antidepressant-induced Paradoxical Anxiety, Akathisia, and Complex
Vocal Tics in a Patient with Panic Disorder and Crohn’s Disease: A Case
Report
Volume: 19
Issue: 4
Author(s): Azriel HK Koh*, Soon Shan Loh and Leslie Lim
Affiliation:
- Department of Psychiatry, Singapore General Hospital, Outram Road, Singapore
Keywords:
Antidepressant, fluvoxamine, paradoxical anxiety, akathisia, tics, panic disorder, crohn’s disease.
Abstract:
Background: Antidepressant-induced paradoxical anxiety is a fairly common phenomenon
seen in patients who are initiated on antidepressants. However, akathisia is a very uncommon
manifestation of antidepressants. Much more rarely, antidepressants are also associated
with the emergence of motor and vocal tics. This case adds to the growing literature of rare adverse
events induced by antidepressants and aims to stimulate future research into the mechanism
and risk factors of this phenomenon.
Case Presentation: In this case report, we describe a patient with panic disorder and co-morbid
Crohn’s disease who developed worsening anxiety, akathisia and vocal tics upon initiation of
fluvoxamine. This is the first case report to describe the emergence of both akathisia and vocal
tics in the same patient following antidepressant initiation. After discontinuation of fluvoxamine,
the patient’s symptoms resolved.
Conclusion: Antidepressant-induced akathisia and tics are often distressing both to the patient
and their loved ones, and can be very puzzling to the clinician. It is important for clinicians to
recognise that, although rare, antidepressants can adverse effects. When these symptoms arise, it
should prompt immediate discontinuation of the offending antidepressant.
