Extrapyramidal symptoms associated with the adjunct of nortriptyline to a venlafaxine-valproic acid combination

The onset of extrapyramidal symptoms has been traditionally linked to the p rescription of neuroleptic treatment: there are some reports in the interna tional literature describing extrapyramidal effects related to antidepressa nt. In this paper we present a case under multiple pharmacologic treatment in whom extrapyramidal symptoms developed shortly after the adjunct of nort riptyline to a combination of venlafaxine and valproic acid administered fo r several months. We describe here the clinical history of this patient, af fected by Bipolar Disorder, type II, and the progressive pharmacologic path in his treatment. Possible hypothesis to explain this evidence are discuss ed. Int ClIin Psychopharmacol 14:197-198 (C) 1999 Lippincott Williams & Wil kins.