A Case of Severe Parkinsonism Associated With Short-term Treatment With Milnacipran

Abstract

A 51-year-old woman became depressed following the death of her father-in-law. She was given 50 mg of milnacipran a day. One week after starting milnacipran, she developed parkinsonism. The milnacipran was increased to 100 mg/d, resulting in a situation where her symptoms of parkinsonism and depression worsened, which was associated with the reduction of 125I-meta-iodobenzylguanidine (MIBG) uptake. Three hundred milligrams of levodopa plus 30 mg of carbidopa was subsequently added to her medications. However, her symptoms still continued for 2 more weeks. Then the milnacipran was tapered, and she was given fluvoxamine with levodopa plus carbidopa. The parkinsonism and the depression gradually improved within 1 month after starting the regimen of fluvoxamine. The MIBG uptake also recovered (Heart to Lung ratio, 2.1) within 2 months. To our knowledge, this is the second reported case of parkinsonism associated with the use of serotonin noradrenaline reuptake inhibitor. This case showed a transient reduction of MIBG uptake associated with the parkinsonism and depression. Clinicians should be aware that serotonin noradrenaline reuptake inhibitors as well as selective serotonin reuptake inhibitors can cause parkinsonism.

Abbreviations: SSRI, selective serotonin reuptake inhibitor, SNRI, serotonin noradrenaline reuptake inhibitor, MIBG, 125I-meta-iodobenzylguanidine