Antidepressants-induced movement disorders are rare and imperfectly known adverse drug reactions. The risk may differ between different antidepressants and antidepressants’ classes. The objective of this study was to assess the putative association of each antidepressant and antidepressants’ classes with movement disorders. Using VigiBase®, the WHO Pharmacovigilance database, disproportionality of movement disorders’ reporting was assessed among adverse drug reactions related to any antidepressant, from January 1967 to February 2017, through a case/non-case design. The association between nine subtypes of movement disorders (akathisia, bruxism, dystonia, myoclonus, parkinsonism, restless legs syndrome, tardive dyskinesia, tics, tremor) and antidepressants was estimated through the calculation first of crude Reporting Odds Ratio (ROR), then adjusted ROR on four potential confounding factors: age, sex, drugs described as able to induce movement disorders, and drugs used to treat movement disorders. Out of the 14,270,446 reports included in VigiBase®, 1,027,405 (7.2%) contained at least one antidepressant, among whom 29,253 (2.8%) reported movement disorders. The female/male sex ratio was 2.15 and the mean age 50.9 ± 18.0 years. We found a significant increased ROR for antidepressants in general for all subtypes of movement disorders, with the highest association with bruxism (ROR 10.37, 95% CI 9.62–11.17) and the lowest with tics (ROR 1.49, 95% CI 1.38–1.60). When comparing each of the classes of antidepressants with the others, a significant association was observed for all subtypes of movement disorders except restless legs syndrome with serotonin reuptake inhibitors (SRIs) only. Among antidepressants, mirtazapine, vortioxetine, amoxapine, phenelzine, tryptophan and fluvoxamine were associated with the highest level to movement disorders and citalopram, paroxetine, duloxetine and mirtazapine were the most frequently associated with movement disorders. An association was also found with eight other antidepressants. A potential harmful association was found between movement disorders and use of the antidepressants mirtazapine, vortioxetine, amoxapine, phenelzine, tryptophan, fluvoxamine, citalopram, paroxetine, duloxetine, bupropion, clomipramine, escitalopram, fluoxetine, mianserin, sertraline, venlafaxine and vilazodone. Clinicians should beware of these adverse effects and monitor early warning signs carefully. However, this observational study must be interpreted as an exploratory analysis, and these results should be refined by future epidemiological studies.

中文翻译：

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抗抑郁药和运动障碍：世界药物警戒数据库中的上市后研究。

抗抑郁药引起的运动障碍很罕见，而且药物不良反应不完善。不同抗抑郁药和抗抑郁药类别之间的风险可能有所不同。这项研究的目的是评估每种抗抑郁药和抗抑郁药类别与运动障碍的假定联系。1967年1月至2017年2月，通过病例/非病例设计，使用WHO WHO药物警戒数据库VigiBase®，评估了运动障碍报告的不成比例性，评估了与任何抗抑郁药相关的不良药物反应。通过首先计算粗略的报告几率（ROR），首先估算出运动障碍的9种亚型（静坐症，磨牙症，肌张力障碍，肌阵挛，帕金森病，腿不安综合征，迟发性运动障碍，抽动，震颤）与抗抑郁药之间的关联，然后针对四个潜在的混杂因素调整了ROR：年龄，性别，被描述为能够诱发运动障碍的药物以及用于治疗运动障碍的药物。VigiBase®包含的14,270,446个报告中，1,027,405（7.2％）包含至少一种抗抑郁药，其中29,253（2.8％）个报告了运动障碍。男女比例为2.15，平均年龄为50.9±18.0岁。我们发现在所有运动障碍亚型中，抗抑郁药的ROR普遍升高，与磨牙症的相关性最高（ROR 10.37，95％CI 9.62-11.17），与抽动相关性最低（ROR 1.49，95％CI 1.38-1.60） 。在将每种抗抑郁药与其他抗抑郁药进行比较时，观察到所有运动障碍亚型之间的显着相关性，只有腿不安综合症仅与5-羟色胺再摄取抑制剂（SRIs）相关。在抗抑郁药中，米氮平，伏替西汀，阿莫沙平，苯乙嗪，色氨酸和氟伏沙明与运动障碍的相关性最高，而西酞普兰，帕罗西汀，度洛西汀和米氮平与运动障碍的相关性最高。还发现与其他八种抗抑郁药有关联。在运动障碍和使用抗抑郁药米氮平，伏替西汀，阿莫沙平，苯乙肼，色氨酸，氟伏沙明，西酞普兰，帕罗西汀，度洛西汀，安非他酮，氯米帕明，依西酞普兰，氟西汀，米安色林，舍曲酮之间存在潜在的有害联系。临床医生应提防这些不良反应，并仔细监测预警信号。但是，该观察性研究必须解释为探索性分析，并且这些结果应通过未来的流行病学研究加以完善。