Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0040822 (tremor)
 18,428 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors describe two series of patients: 12 treated simultaneously with fluoxetine and a monoamine oxidase inhibitor and 6 patients started on treatment with an MAOI 10 days or more after stopping fluoxetine treatment. All patients had extremely refractory depression and were treated in open fashion before general knowledge was obtained of the side effects that may accompany the fluoxetine-MAOI combination. During the fluoxetine-MAOI trial, most patients continued to receive other psychotropic combinations that had been partially helpful. The use of fluoxetine and an MAOI, either together or in close succession, was accompanied by a very high incidence of adverse effects, especially the "serotonergic syndrome." This syndrome was characterized by mental status changes, such as hypomania and confusion, and physical symptoms, such as myoclonus, hypertension, tremor, and diarrhea. Because of the high incidence of side effects and the lack of definite efficacy, the concurrent use of fluoxetine and MAOIs should generally be avoided. The long half-lives of fluoxetine and norfluoxetine, as well as the prolonged metabolic effects of MAOIs, may also dispose patients to an interaction if one of the drugs is started soon after stopping the other.
 ...
PMID:Adverse consequences of fluoxetine-MAOI combination therapy. 199 42

In animals the occurrence of a behavioural syndrome consisting of hyperactivity, stereotyped movements and increase of temperature has been induced by MAOIs, 5-HT precursors (L-tryptophan) and 5-HT reuptake inhibitors. Most of these manifestations were specifically blocked by a pretreatment with an inhibitor of serotonin synthesis. In humans, the association of myoclonus, diarrhea, confusion, hypomania, agitation, hyperreflexia, shivering, incoordination, fever and diaphoresis, when patients are treated with serotoninergic agents, could constitute a "serotonin syndrome". Such cases of serotonin syndrome were reported after treatments with L-tryptophan, MAOIs, serotonin reuptake inhibitors and tricyclics alone or in association. The authors prospectively evaluated all the "serotonin-related" symptoms in 38 depressed inpatients fulfilling DSM III-R criteria of major depression. 16 (42%) out of 38 patients presented at least one symptom of serotonin syndrome. In 14 cases tremor and myoclonus occurred simultaneously and 10 patients presented at the same time tremor, myoclonus, diaphoresis and shivering. Except for two patients, symptoms were transient, lasted less than one week and disappeared with the pursuit of the treatment. Most often, serotonin syndrome thus corresponds to a reaction induced by a combination of serotoninergic agents at high dosages. In very rare cases, a toxic and potentially fatal interaction can occur between MAOIs, tricyclics and selective serotonin reuptake inhibitors at therapeutic dosages. Serotonin syndrome also provides an heuristic model of the putative mode of action of antidepressants. Serotonin-related symptoms are the physical and objective expression of the antidepressant-induced increase in serotonin. The specificity of serotonin-related syndrome also needs to be discussed since most of the symptoms, such as tremor and diaphoresis, are not in all cases related to an increase in serotonin.
 ...
PMID:[The serotonin syndrome: review of the literature and description of an original study]. 852 62

Serotonin syndrome, a condition with numerous clinical neurological manifestations, is the result of central serotonergic hyperstimulation. Features of the syndrome include mental status and behavioral changes (agitation, excitement, hypomania, obtundation), motor system involvement (myoclonus, hemiballismus, tremor, hyperreflexia, motor weakness, dysarthria, ataxia) and autonomic symptoms (fever, chills, diarrhea). Serotonin syndrome has been reported exclusively in patients on medications for psychiatric illness and Parkinsonism, despite the fact that the putative action of many antimigraine agents also involves the serotonin system. We herein report six patients with migraine who developed symptoms suggestive of the serotonin syndrome. Five were taking one or more serotomimetic agents for migraine prophylaxis (sertraline, paroxetine, lithium, imipramine, amitriptyline). In each case the symptoms and signs developed in close temporal proximity with use of a migraine abortive agent known to interact with serotonin receptors. In three instances the agent was subcutaneous sumatriptan and, in three, intravenous dihydroergotamine. In each instance the symptoms were transient and there was full recovery. With the ever increasing use of migraine medications active at serotonin receptor sites, cases of serotonin syndrome will likely occur more frequently. It is important that physicians treating migraine are aware of the serotonin syndrome and are able to recognize its varying presentations.
 ...
PMID:Serotonin syndrome complicating migraine pharmacotherapy. 886 67

Symptoms of behavioral activation in children and adolescents have been reported as possible adverse effects of treatment with fluoxetine and sertraline. A 15-year-old with a single major depressive episode, dissociative periods, and anxious hyperventilation attacks was started on sertraline 50 mg (1 mg/kg) daily and, within 4 days, raised to 100 mg daily. All major symptoms resolved by 4 weeks with no apparent side effects or adverse behavioral changes. Ratings of Global Assessment of Functioning and Clinical Global Impression Severity of Illness ratings reflected marked clinical improvement. The adolescent remained euthymic for 6 months but then experienced a return of some depressive symptoms. Within 3 days of raising the dose to 150 mg daily, the patient began to exhibit difficulty in falling asleep, hypermotoric behavior, and hypertalkativeness (in association with tremor and blurred vision). This episode was not of sufficient duration and did not fulfill a sufficient number of DSM-IV criteria to qualify as hypomania. The symptoms of behavioral activation lasted for 3 days and disappeared when sertraline was discontinued, but depressive and hyperventilation symptoms returned quickly. Reinstatement of 100 mg produced enduring recovery without the adverse effects. This case appears to suggest that rapid dose elevation may not be as important as dose quantity in eliciting adverse behavioral effects from sertraline. Judging from the few cases now in the medical literature, it appears that sertraline-induced behavioral activation may emerge at doses that vary considerably among individual youths (25-200 mg daily). In short, this drug-induced behavioral activation appears to be dose-dependent, but dose threshold varies widely among patients.
 ...
PMID:Sertraline-induced behavioral activation during the treatment of an adolescent with major depression. 923 21

Subthalamic nucleus deep brain stimulation (STN DBS) is an established treatment that improves motor fluctuations, dyskinesia, and tremor in Parkinson's disease (PD). After the surgery, a careful electrode programming strategy and medical management are crucial, because an imbalance between them can compromise the quality of life over time. Clinical management is not straightforward and depends on several perioperative motor and non-motor symptoms. In this study, we review the literature data on acute medical management after STN DBS in PD and propose a clinical algorithm on medical management focused on the patient's phenotypic profile at the perioperative period. Overall, across the trials, the levodopa equivalent daily dose is reduced by 30 to 50% one year after surgery. In patients taking high doses of dopaminergic drugs or with high risk of impulse control disorders, an initial reduction in dopamine agonists after STN DBS is recommended to avoid the hyperdopaminergic syndrome, particularly hypomania. On the other hand, a rapid reduction of dopaminergic agonists of more than 70% during the first months can lead to dopaminergic agonist withdrawal syndrome, characterized by apathy, pain, and autonomic features. In a subset of patients with severe dyskinesia before surgery, an initial reduction in levodopa seems to be a more reasonable approach. Finally, when the patient's phenotype before the surgery is the severe parkinsonism (wearing-off) with or without tremor, reduction of the medication after surgery can be more conservative. Individualized medical management following DBS contributes to the ultimate therapy success.
 ...
PMID:Medical management after subthalamic stimulation in Parkinson's disease: a phenotype perspective. 3229 47

Lithium has been used effectively used in the management of mood disorders, such as bipolar disease, acute mania, and hypomania. As the therapeutic index is very narrow for lithium, it is important to monitor lithium levels periodically to avoid toxic effects. Common toxic effects include diarrhea, tremor, muscle weakness, ataxia, and myoclonus. Severe toxicity can present with seizures, coma, and death. Cardiotoxicity secondary to lithium is rarely reported in the medical literature and can range from dysrhythmias and cardiomyopathies to myocardial infarction. We describe an interesting case report of cardiac toxicity secondary to lithium in a bipolar patient managed conservatively in an intensive care setting.
 ...
PMID:Lithium-induced Cardiotoxicity: A Rare Clinical Entity. 3278 90