Antidepressant exacerbation of spasticity

Patients with spinal cord injury (SCI) may develop depression. This may be related to adjustment to living with an SCI in addition to dealing with com plications of the injury, such as spasticity. Pharmacologic treatment of de pression can be difficult because of neurochemical and receptor changes tha t are associated with SCI. Newer antidepressant agents are purported to hav e selective activity by alteration of serotonergic neurotransmission. A cas e report is presented that illustrates exacerbation of spasticity by this f amily of antidepressant medications. Mechanisms possibly explaining this ex acerbation of spasticity are the effects of serotonin on motor neuron and r eflex activity, denervation supersensitivity, and the serotonin syndrome. U nderstanding the relationship between serotonergic systems and spasticity c an be important in treating depression in patients with spasticity, (C) 199 9 by the American Congress of Rehabilitation Medicine and the American Acad emy of Physical Medicine and Rehabilitation.