NEUROLEPTIC MALIGNANT SYNDROME UNDER TREATMENT WITH ANTIDEPRESSANTS -A CRITICAL-REVIEW

Neuroleptic malignant syndrome (NMS) is a rare complication of treatme nt with neuroleptics. The pathophysiology is not fully known. A dopami nergic transmission block in the basal ganglia and hypothalamus is tho ught to be the pathophysiological mechanism of NMS. Several cases of N MS have been reported, precipitated by medication without a direct eff ect on the dopaminergic system. This Medline analysis concerns 23 case s of antidepressant-induced NMS reported in the literature with the di ffering pathophysiological hypotheses on the precipitation of NMS. The results indicate no hard evidence of an antidepressant-evoked NMS. Ho wever, various hypotheses assuming an disturbed balance of the dopamin ergic and non-dopaminergic system may be relevant in animal studies, b ut are without clinically relevant proof presently. An antidepressant- induced NMS is a very rare complication on the basis of pretreatment w ith neuroleptics causing chronic dopamine blockade and elevated plasma level of neuroleptics due to comedicated antidepressants.