Acute Dystonia after Using Single Dose Duloxetine: Case Report
Miss. M. is a 19-year-old, female patient. She was referred to the emergency service with a sudden onset of severe neck spasm and pain, distortion of head, mild tremor in her hands and lips, mild pouting, movement of forehead and jaw cleching. The patient was aware of this situation and was in severe distress. She said that her complaints have started after 10 hours of taking only one dose of duloxetine 30 mg. Duloxetine 30 mg/day had been prescribed by another psychiatrist for her anxiety symptoms. She did not take any medication except duloxetine 30 mg/day. She did not have any history of head trauma, seizure, medical disease, substance abuse or family history of neuropsychiatric disorders.\nThe clinical presentation was interpreted as dystonia and Abnormal Involuntary Movement Scale (AIMS) was performed. The AIMS score was 22. Within 30 minutes after par-enteral 5 mg biperiden administration, all signs and symptoms improved and dystonia were not observed throughout the 6-hour emergency service monitoring. During her treatment, a series of laboratory tests was performed to rule out secondary dystonia. These tests included complete blood count, erythrocyte sedimentation rate, liver, renal and thyroid function tests, blood glucose level, serum copper, zinc, iron, magnesium, ceruloplasmin level, total iron binding capacity, serum ferritin, vitamin B12, folic acid level, cranial magnetic resonance imaging and electroencephalogram. These examinations showed no specific findings. Thus, this manifestation was evaluated as duloxetine induced dystonia. Duloxetine was stopped. She regularly attended psychotherapy for anxiety disorder, not otherwise specified according to diagnostic criteria of DSM-IV. She was followed up six months without medication. Anxiety symptoms were not observed after pshchotherapy and also dystonia did not appear again during this period.