SSRi-induced Parkinsonism

[sovietxrobot]

Dixit, S., et al. A case of SSRI induced irreversible Parkinsonism. 2015. J Clin Diag Res. 9(2):VD01-VD02.

Summary- the subject abruptly discontinued SSRI (fluxetine/sertraline) and developed Parkinson's symptoms. Symptoms were relieved with synthetic dopamine treatment (syncope); after discontinuation of treatment, symptoms returned.

Its not exactly new information, but this study is further evidence of the role of dopamine disregulation in PSSD. This case was particularly severe and the paper suggests that he may have had pre-existing Parkinsons.

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What if pssd is a SSRI-induced mild case of "parkinsons" that does not progress. Early signs of dysfunction in the dopamine system in the brain will show up as anhedonia, akathisia, sexual dysfunction, depression, and cognitive impairment (brain fog.) People with early parkinsons will often have these symptoms decades before obvious signs of the disease show up and they get diagnosed.

[quagmire]

Pssd could be caused by inhibition of dopamine, and or lack of dopamine. Many with PSSD suffer from anhedonia (Anhedonia and sexual anhedonia). If you lower dopamine you will get anhedonia and could also suffer derealization/depersonalization symptoms and other dysphoric feelings.

From wikipedia (Sexual anhedonia):

"Normally, a human being is able to feel pleasure from an orgasm. Upon reaching a climax, chemicals are released in the brain and motor signals are activated that will cause quick cycles of muscle contraction in the corresponding areas of both males and females. Sometimes, these signals can cause other involuntary muscle contractions such as body movements and vocalization. Finally, during orgasm, upward neural signals go to the cerebral cortex and feelings of intense pleasure are experienced. People who have this disorder are aware of reaching an orgasm, as they can feel the physical effects of it, but they experience very limited or no sort of pleasure

Causes
It is thought that people who suffer from this disorder, suffer from a dysfunction in the release of the chemical dopamine in the nucleus accumbens, the brain's primary reward center. This part of the brain is thought to play a role in pleasurable activities, including laughter, addiction, and music. Additionally, it is thought that depression, drug addiction, high levels of prolactin, low testosterone, and uses of certain medications might play a role in inhibiting dopamine. A spinal cord injury or chronic fatigue syndrome might also occasionally cause this disorder. Age may also be a cause of this disorder"

In a review of the literature, 71 cases of selective serotonin reuptake inhibitor (SSRI)-associated extrapyramidal symptoms were found.4 Of these cases, akathisia was the most common, followed by dystonia, parkinsonism, and tardive dyskinesia–like states. It has been theorized to be caused by stimulating 5-hydroxy-tryptamine 2 receptors in the serotonin pathway that projects to the basal ganglia. This may cause a serotonin-mediated inhibition of dopamine release from the basal ganglia, resulting in a dopamine deficiency.

"Extrapyramidal symptoms" wikipedia:

Short and long-term use of antidepressants such as selective serotonin reuptake inhibitors (SSRI), serotonin-norepinephrine reuptake inhibitors (SNRI), and norepinephrine-dopamine reuptake inhibitors (NDRI) have also resulted in EPS (extrapyramidal symptoms) Specifically, duloxetine, sertraline, escitalopram, fluoxetine, and bupropion have been linked to the induction of EPS. Other causes of extrapyramidal symptoms can include brain damage and meningitis.