121

B. Kaya, M. Güzelipek, M. E. Özcan

Klinik Psikofarmakoloji Bülteni, Cilt: 11, Say›: 2, 2001 / Bulletin of Clinical Psychopharmacology, Vol: 11, N.: 2, 2001

INTRODUCTION

O

bsessive-compulsive disorder (OCD) is a chronic

disorder which may frequently be seen with

major depression and which may also be resistant to

pharmacotherapy (1). Fluoxetine has the advantage

of carrying both antidepressant and antiobsessive

effects. Antipsychotics may be added, if the patient

is resistant (2). Sulpiride is a well-known

antipsychotic with less side effects below 400

mg/day (3). There are limited studies about the anti-

depressant effect of sulpiride but recent data sug-

gests that it is effective in depression and is well tol-

erated at 400-1200 mg. Whether this effect is anti-

depressant or antipsychotic, it is unknown. In a

study of depressive patients, a single low dose of

sulpiride was given and the side effects were moder-

ate sedation, constipation and dry mouth (4). In

another double-blind comparative study of bipolar

depression, sulpiride was combined with lithium.

Depression and anxiety recovered very well and there

were no side effects (5).

This case report discusses a case of OCD and

comorbid major depression, who had severe

extrapyramidal side effects during a combination

treatment with fluoxetine and sulpiride.

Case report

The case was a 53 years old, female. She had

ABSTRACT:

SEVERE EXTRAPYRAMIDAL SYMPTOMS DUE TO SULPIRIDE

AND FLUOXETINE COMBINATION IN A CASE OF OCD

Sulpiride is an antipsychotic agent which has an antidepressant

effect in low doses. The combination of antipsychotics in lower

dosages with antidepressants in obsessive-compulsive disorder

(OCD) patients has also been reported to be useful. The case

reported was a 53 years old female patient with OCD and major

depression according to the DSM-IV diagnostic criteria. OCD

diagnosis was present for six years and she had been

depressied for the last six months. She was accepted as having

resistant OCD according to the patient’s history. After she was

hospitalized, the treatment began with fluoksetin 20 mg/day. In

the second week fluoksetin dosage was raised to 40 mg/day

and 200 mg/day sulpiride was added. On the third day of com-

bination treatment, severe extrapyramidal symptoms emerged

and this prompted us to quit the use of sulpiride. Biperiden 3

mg/day was ordered in order to relieve those side effects. As

these precautions were not efficacious, fluoksetin dosage was

lowered to 20 mg/day, and then it was quitted.

Diphenhidramine 100 mg/day, propranolol 40 mg/day and

diazepam 10 mg/day were ordered. Except chewing move-

ments extrapyramidal symptoms lasted for a week.

Key words: obsessive-compulsive disorders, extrapyramidal

symptoms, sulpiride, fluoksetine, drug interaction

Bull Clin Psychopharmacol 2001;11:121-123

ÖZET:

SÜLP‹R‹D VE FLUOKSET‹N’‹N B‹RL‹KTE KULLANIMINA BA/LI

OLARAK fi‹DDETL‹ EKSTRAP‹RAM‹DAL YAN ETK‹ ORTAYA

ÇIKAN B‹R OKB OLGUSU

Dü?ük dozlarda kullan›lan sülpiridin antidepresan etkinlik gös-

terdi¤i bilinmektedir. Obsesif kompulsif bozuklu¤un (OKB)

tedavisinde dü?ük dozlarda antidepresan ilaçlarla birlikte kul-

lan›labilmektedir. DSM-V’e göre OKB ve major depresyon tan›s›

konan 53 ya?›nda bayan hasta. 6 y›ld›r süren OKB’u, 6 ayd›r

süren depresyonu var. Dirençli OKB olarak kabul edilen ve has-

taneye yat›r›lan hastaya 20 mg/gün fluoksetin ba?land›. 1 hafta

sonra doz 40 mg’a yükseltildi ve 200 mg sülpirid eklendi.

Tedavinin 3. gününde ?iddetli ekstrapiramidal yan etkiler ortaya

ç›kt›. Bunun üzerine sülpirid kesildi. Fluoksetin dozu 20 mg’a inil-

di. Tedaviye 100 mg/gün difenhidremin, 40 mg/gün propra-

nolol ve 10 mg/gün diazepam eklendi. Bir hafta içinde çi¤neme

hareketleri d›?›ndaki ekstra piramidal sistem belirtilerinde belir-

gin düzelme gözlendi.

Anahtar sözcükler: obsesif kompulsif bozukluk, ekstrapiramidal

belirtiler, sülpirid, fluoksetin, ilaç etkile?imi

Klinik Psikofarmokoloji Bülteni 2001;11:121-123

*This article was presented at Regional Congress of Biological Psychiatry, 3-5 July 2000, ‹stanbul, Turkey

1

‹nönü University Medical School Departments of Psychiatry,

2

‹nönü University Medical School Departments of Neurology

Yaz›?ma Adresi / Address reprint requests to: Y. Doç. Dr. Burhanettin Kaya, ‹nönü Ü. T›p Fakültesi, Turgut Özal T›p Merkezi, Psikiyatri AD 44069-Malatya-Turkey

Tel: +90 (422) 341 0660/5407 Faks: +90 (422) 341 0728 E-mail: burha@usa.net

Kabul tarihi: 17 Nisan 2001

Severe Extrapyramidal Symptoms Due to Sulpiride and

Fluoxetine Combination in a Case of OCD*

Burhanettin Kaya M.D.

1

, Mehmet Güzelipek M.D.

2

, M. Erkan Özcan M.D.

1