The Dark Side of Combination Therapy: Tardive Dyskinesia in an Autistic Patient Using Fluoxetine and Dual Antipsychotics
Case Report
P: 99-102
March 2024

The Dark Side of Combination Therapy: Tardive Dyskinesia in an Autistic Patient Using Fluoxetine and Dual Antipsychotics

Turk J Child Adolesc Ment Health 2024;31(1):99-102
1. Kırklareli Eğitim ve Araştırma Hastanesi, Çocuk ve Ergen Psikiyatri Kliniği, Kırklareli, Türkiye
2. Trakya Üniversitesi Tıp Fakültesi, Çocuk ve Ergen Psikiyatri Anabilim Dalı, Edirne, Türkiye
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Received Date: 15.02.2023
Accepted Date: 08.01.2024
Publish Date: 27.03.2024


In recent years, in addition to the use of antipsychotics, case reports of extra-pyramidal symptoms (EPS) associated with the use of selective serotonin reuptake inhibitors have been reported with increasing frequency. Tardive dyskinesia, one of the EPS, is a serious movement disorder that is difficult to treat and can lead to impaired social functioning. Occurrence during the stable course of the treatment may increase the risk of being undiagnosed in the clinic. In this study, tardive dyskinesia symptoms, differential diagnosis and treatment process developed after fluoxetine dose increase in an adolescent patient with autism who has been using fluoxetine treatment for the last 6 years in addition to dual atypical antipsychotic (risperidone and aripiprazole) treatment, which she has been using for 11 years, are shared.

Keywords: Fluoxetine, tardive dyskinesia, antipsychotic, child, autism


Gupta S, Mosnik D, Black DW, Berry S, Masand PS. Tardive dyskinesia: review of treatments past, present, and future. Ann Clin Psychiatry. 1999;11:257-266.
Egan MF, Apud J, Wyatt RJ. Treatment of tardive dyskinesia. Schizophr Bull. 1997;23:583-609.
Jeste DV, Lacro JP, Palmer B, Rockwell E, Harris MJ, Caligiuri MP. Incidence of tardive dyskinesia in early stages of low-dose treatment with typical neuroleptics in older patients. Am J Psychiatry. 1999;156:309-311.
Woerner MG, Alvir JMJ, Saltz BL, Lieberman JA, Kane JM. Prospective study of tardive dyskinesia in the elderly: rates and risk factors. Am J Psychiatry. 1998;155:1521-1528.
Coulter DM, Pillans PI. Fluoxetine and extrapyramidal side effects. Am J Psychiatry. 1995;152:122-125.
Bonin B, Vandel P, Sechter D, Bizouard P. Paroxetine and galactorrhea. Pharmacopsychiatry. 1997;30:133-134.
Diler RS, Yolga A, Avci A. Fluoxetine-induced extrapyramidal symptoms in an adolescent: a case report. Swiss mMed Week. 2002;132:125-126.
Leo RJ. Movement disorders associated with the serotonin selective reuptake inhibitors. J Clin Psychiatry. 1996;57:449-454.
Fernandez HH, Friedman JH. Classification and treatment of tardive syndromes. The nNeurologist. 2003;9:16-27.
Correll CU, Schenk EM. Tardive dyskinesia and new antipsychotics. Curr Opin Psychiatry. 2008;21:151-156.
Weiner WJ, Lang AE. Movement Disorders: A Comprehensive Survey - Hardcover. 1989.
Margolese HC, Chouinard G, Kolivakis TT, Beauclair L, Miller R. Tardive dyskinesia in the era of typical and atypical antipsychotics. Part 1: pathophysiology and mechanisms of induction. Can J Psychiatry. 2005;50:541-547.
Demirkol ME, Şenbayram Ş, Doğangüneş G, Tamam L. Tardif diskinezi ve tedavi yaklaşımları. Psikiyatride Güncel Yaklaşımlar. 2018;10:249-264.
Gill HS, DeVane CL, Risch SC. Extrapyramidal symptoms associated with cyclic antidepressant treatment: a review of the literature and consolidating hypotheses. J Clin Psychopharmacol1997;17:377-389.
Caley CF. Extrapyramidal reactions and the selective serotonin-reuptake inhibitors. Ann Pharmacother1997;31:1481-1489.
Schillevoort I, Van Puijenbroek E, de Boer A, Roos R, Jansen PA, Leufkens H. Extrapyramidal syndromes associated with selective serotonin reuptake inhibitors: a case-control study using spontaneous reports. IntClin Psychopharmacol. 2002;17:75-79.
Kapur S, Remington G. Serotonin-dopamine interaction and its relevance to schizophrenia. Am J Psychiatry. 1996;153:466-476.
DeVane CL. Pharmacogenetics and drug metabolism of newer antidepressant agents. J Clin Psychiatry. 1994;55:38-45.
DeVane CL. Pharmacokinetics of the newer antidepressants: clinical relevance. Am JMed. 1994;97:13-23.
Steur EN. Increase of Parkinson disability after fluoxetine medication. Neurology. 1993;43:211-213.
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