0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

1
Letters   |    
Aripiprazole for the Treatment of Involuntary Movement Symptoms in Patients With Major Depressive Disorder
Won Sub Kang, M.D.; Jin Kyung Park, M.D., Ph.D.; Ah Rang Cho, M.D., Ph.D.
The Journal of Neuropsychiatry and Clinical Neurosciences 2012;24:E05-E06. doi:10.1176/appi.neuropsych.11090219
View Author and Article Information

Correspondence: A.R. Cho, M.D., Ph.D., Dept. of Psychiatry, School of Medicine, Kyung Hee University, Hospital at Gangdong, Seoul, Republic of Korea; e-mail: menuhin@hanmail.net

To the Editor: Somatic symptoms such as involuntary movement symptoms sometimes emerge with depressive disorder. Here, we present two cases exhibiting the remarkable therapeutic effects of aripiprazole with respect to involuntary movement symptoms with major depressive disorder.

The first patient, a 58-year-old married woman with anxiety, depressed mood, and somatic complaints, including involuntary rhythmic movements of the head and neck, was diagnosed with major depressive disorder. After prescribing 10 mg/day escitalopram, 1 month later, depressive symptoms were mildly improved, but intermittent movement symptoms remained. To reduce movement symptoms and augment antidepressant effects, aripiprazole was prescribed at 5 mg/day, then titrated to 10 mg/day. Three weeks later, involuntary movement symptoms and depressive symptoms were alleviated. Five months later, she stopped her medicine at her discretion and movement symptoms recurred. On 7.5 mg/day of aripiprazole, the patient was stabilized, with no signs of depressive symptoms or involuntary movement symptoms.

The second patient, a 62-year-old married man, presented with depressed mood and involuntary head and neck movements, was diagnosed with depressive disorder. He was given paroxetine 12.5 mg/day and escitalopram 10 mg/day, but his depressed mood remained. One month later, aripiprazole 2.5 mg/day was started because of the persistence of movement symptoms. The following week, aripiprazole was raised to 10 mg/day, resulting in a significant improvement in his involuntary movements and depressed mood. His movement symptoms reemerged after 7 months, after giving up treatment against our advice. One month after the reinitiation of aripiprazole 10 mg/day, abnormal movements were remitted considerably. During the follow-up, there were no further involuntary movement symptoms or depressive symptoms.

These involuntary movement symptoms were different from tics and parkinsonian symptoms. Also, brain magnetic resonance imaging (MRI) results showed no abnormal finding. There have been conflicting results about the relationship between aripiprazole and movement disorders. There have been case reports that aripiprazole is effective in tardive dyskinesia.1 On the other hand, there have been other cases suggesting that aripiprazole may be more likely to cause movement disorders than other atypical antipsychotics.2 Aripiprazole is considered as a dopaminergic stabilizer because of its partial agonism at postsynaptic D2 and D3 receptors.3 It has been postulated that aripiprazole’s 5-HT2A receptor antagonist activity with partial D2 agonist properties and its rapid dissociation from dopamine receptors may account for its relatively low effect of extrapyramidal symptoms.4

The extrapyramidal motor system has been clearly implicated in certain tremors and chorea. Furthermore, involuntary movements have been often associated with dysfunction of basal ganglia. Within the basal ganglia, the D2 and D3 receptors are expressed, and, thus, agonism at these receptors may result in the relief of the motor symptoms.5 Because of its partial agonist effect on 5-HT1A and antagonist activity at 5-HT2A receptors, aripiprazole has been known to exert neuromodulatory effects on the serotonergic system, which may explain the improvement in movement symptoms in our cases.

The present case reports have suggested that because of its unique feature as a dopamine stabilizer, aripiprazole’s use in depression with movement symptoms in elderly patients may be promising. However, further studies will be needed to elucidate potential mechanism of action of aripiprazole in treating depression with movement symptoms.

The authors declare that there are no conflicts of interest.

Rajarethinam  R;  Dziuba  J;  Manji  S  et al:  Use of aripiprazole in tardive dyskinesia: an open-label study of six cases.  World J Biol Psychiatry 2009; 10:416–419
[CrossRef] | [PubMed]
 
Hall  DA;  Agarwal  P;  Griffith  A  et al:  Movement disorders associated with aripiprazole use: a case series.  Int J Neurosci 2009; 119:2274–2279
[CrossRef] | [PubMed]
 
Lykouras  L;  Rizos  E;  Gournellis  R:  Aripiprazole in the treatment of tardive dyskinesia induced by other atypical antipsychotics.  Prog Neuropsychopharmacol Biol Psychiatry 2007; 31:1535–1536
[CrossRef] | [PubMed]
 
Mamo  D;  Graff  A;  Mizrahi  R  et al:  Differential effects of aripiprazole on D2, 5-HT2, and 5-HT1A receptor occupancy in patients with schizophrenia: a triple tracer PET study.  Am J Psychiatry 2007; 164:1411–1417
[CrossRef] | [PubMed]
 
Khan  ZU;  Gutiérrez  A;  Martín  R  et al:  Differential regional and cellular distribution of dopamine D2-like receptors: an immunocytochemical study of subtype-specific antibodies in rat and human brain.  J Comp Neurol 1998; 402:353–371
[CrossRef] | [PubMed]
 
References Container
+

References

Rajarethinam  R;  Dziuba  J;  Manji  S  et al:  Use of aripiprazole in tardive dyskinesia: an open-label study of six cases.  World J Biol Psychiatry 2009; 10:416–419
[CrossRef] | [PubMed]
 
Hall  DA;  Agarwal  P;  Griffith  A  et al:  Movement disorders associated with aripiprazole use: a case series.  Int J Neurosci 2009; 119:2274–2279
[CrossRef] | [PubMed]
 
Lykouras  L;  Rizos  E;  Gournellis  R:  Aripiprazole in the treatment of tardive dyskinesia induced by other atypical antipsychotics.  Prog Neuropsychopharmacol Biol Psychiatry 2007; 31:1535–1536
[CrossRef] | [PubMed]
 
Mamo  D;  Graff  A;  Mizrahi  R  et al:  Differential effects of aripiprazole on D2, 5-HT2, and 5-HT1A receptor occupancy in patients with schizophrenia: a triple tracer PET study.  Am J Psychiatry 2007; 164:1411–1417
[CrossRef] | [PubMed]
 
Khan  ZU;  Gutiérrez  A;  Martín  R  et al:  Differential regional and cellular distribution of dopamine D2-like receptors: an immunocytochemical study of subtype-specific antibodies in rat and human brain.  J Comp Neurol 1998; 402:353–371
[CrossRef] | [PubMed]
 
References Container
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Books
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 20.  >
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 31.  >
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 61.  >
Manual of Clinical Psychopharmacology, 7th Edition > Chapter 2.  >
The American Psychiatric Publishing Textbook of Psychiatry, 5th Edition > Chapter 26.  >
Topic Collections
Psychiatric News
Read more at Psychiatric News >>
APA Guidelines
PubMed Articles