Objective: This case report aims to highlight the impact of increasing venlafaxine dose on the worsening of dyskinesias and the onset of ocular dyskinesia³ and alert about this risk.

Background: Parkinson’s disease (PD) is a progressive neurodegenerative disorder associated with cardiovascular, metabolic, and neuropsychiatric comorbidities. Depression, a non-motor complication of PD, negatively affects quality of life and adherence to treatment. The management of these cases is challenging, as antidepressants can interfere with the dopaminergic response and worsen symptoms such as dyskinesias.

Method: The case report was created based on a thorough analysis of the outpatient medical record, with the participation of physicians involved in the patient’s care.

Results: Male patient, 78, diagnosed with PD at the age of 62 underwent deep brain stimulation (DBS) in August 2019. His past medical history includes an ischemic stroke in 2020, pacemaker implantation due to long cardiac pauses, fibrillation and type 2 diabetes mellitus. He was on multiple medications, including antiparkinsonian drugs (LEDD: 1451), antidepressants (mirtazapine 45 mg/day, venlafaxine 75 mg/day), and drugs for the management of his other comorbidities and experienced less then 3 hours of head/neck dyskinesia a day. Due a suicide attempt with posterior hospitalization, venlafaxine was adjusted to 225 mg/day. Three days after increase, he experienced a significant worsening of cephalic dyskinesia and the onset of ocular dyskinetic movements (oculogiric like) without improvement, despite DBS modulation and a reduction in the levodopa dose. However, after reducing venlafaxine to 150 mg/day, there was a marked improvement in dyskinesias.

Conclusion: This case underscores the complexity of managing advanced Parkinson’s disease, particularly when using serotonin–noradrenaline reuptake inhibitors, that do not play a direct role of dopaminergic system, but probably are indirectly influencing, since serotonin and noradrenaline pathways modulate it. An increased venlafaxine dose was followed by worsening dyskinesias and the onset of ocular dyskinesia, suggesting interference with dopaminergic and serotonergic systems⁴. Reducing the dose improved symptoms, emphasizing the need for careful antidepressant adjustments and close collaboration between neurology and psychiatry to optimize motor control.

References: 1. Marsh L. Depression and Parkinson’s disease: current knowledge. Curr Neurol Neurosci Rep. 2013 Dec;13(12):409. doi: 10.1007/s11910-013-0409-5. PMID: 24190780; PMCID: PMC4878671.
2. Revet A, Montastruc F, Roussin A, Raynaud JP, Lapeyre-Mestre M, Nguyen TTH. Antidepressants and movement disorders: a postmarketing study in the world pharmacovigilance database. BMC Psychiatry. 2020 Jun 16;20(1):308. doi: 10.1186/s12888-020-02711-z. PMID: 32546134; PMCID: PMC7298955.
3. Olszewska DA, Shetty R, Geetha TS, Ramprasad VL, Lang AE, Kukkle PL. Oculogyric Crisis Phenotype of Levodopa-Induced Ocular Dyskinesia. Mov Disord Clin Pract. 2022 Feb 10;9(3):390-393. doi: 10.1002/mdc3.13416. PMID: 36989007; PMCID: PMC8974885.
4. Marano M, Pilotto A, Padovani A, Gupta D, Vivacqua G, Magliozzi A, Di Lazzaro V, Carta M, Meloni M. The chronic use of serotonin norepinephrine reuptake inhibitors facilitates dyskinesia priming in early Parkinson’s disease. J Neurol. 2024 Jul;271(7):3711-3720. doi: 10.1007/s00415-024-12400-6. Epub 2024 May 8. PMID: 38720139.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/antidepressants-associated-with-worsening-dyskinesia-in-parkinsons-disease/