Identifying the culprit

Back when I used to go to my local Pd support group a new couple came and one of the first things the wife wanted to know was which drugs to avoid so they didn’t make his Parkinson’s worse. I think my first parkinsonian symptoms appeared after I was given antidepressants.
15/5/02 Sertraline 13 days
19/5/02 all neck tight when walking,
27/5/02 Amitriptyline 2 days
30/5/02 stiffness in neck 1/7/02 pins & needles right arm
9/7/02 neck & shoulder

Understanding drug-induced parkinsonism Separating pearls from oysters M.V.G. Alvarez & V.G.H. Evidente Neurology February 19, 2008 vol. 70 no. 8 e32-e34

However, in any parkinsonian patient, one must obtain a careful medical and medication history, as drug-induced parkinsonism (DIP) is often reversible, especially if the offending drug is discontinued early… Prompt recognition of DIP is the key. The next step is discontinuation of the culprit.

Drug-induced parkinsonism: diagnosis and management P.J.Blanchet, V.Kivenko 23 Sept.2016 vol.6 P.83-91

In a single academic center, only one of 24 patients with DIP had been properly diagnosed prior to referral. The reasons for underdiagnosis are several-fold, including lack of recognition or attribution of the clinical presentation to PD or the mental illness (as apathy, depression, catatonia, psychogenic condition). In wrongly ascribed cases, the drug profile may inadequately be deemed inoffensive (eg, low-dose classical antipsychotics, use of atypical antipsychotics in monotherapy, or hidden neuroleptics).
Chapter 30 Drug-Induced Movement Disorders K.D. Sethi, J. C. Morgan (in Parkinson’s Disease and Movement Disorders ed. J. Jankovic, E.Tolosa 2007 Lippincott Williams & Wilkins)

p.396 Drug-induced parkinsonism: In one study, 51% of 95 patients referred to a geriatric medicine service for evaluation had parkinsonism associated with prescribed drugs. Another study found that in a general neurology practice, 56.8% of 306 cases of parkinsonism were either induced by or aggravated by drugs

Table 30.2 Medications Likely to Induce or Exacerbate Parkinsonism
Table 30.3 Medications that Occasionally Induce or Exacerbate Parkinsonism

In patients who develop DIP, the condition typically develops between 2 weeks and 1 month following introduction of a neuroleptic or an increase in dose.)… In one series, 50%–70% of cases appeared within 1 month and 90% within 3 months

p.400 In general, the presence of multiple movement disorders in a patient should alert the physician to the possibility of a drug-induced disorder

A Case of SSRI Induced Irreversible Parkinsonism S. Dixit, S.A.Khan, and S.Azad J Clin Diagn Res. 2015 Feb; 9(2):
DIP is thought to rank second in order after Parkinson’s disease (PD) in causing Parkinsonism, accounting for up to 20% of the PD cases. Review of case reports related to SSRI induced EPS revealed akathisia (45.1%) followed by dystonic reactions (28.2%), parkinsonism (14.1%) and tardive dyskinesia (11.3%). Elderly, female, pre-existing extrapyramidal disorder and other concurrent neuroleptic medications were considered risk factors . DIP can be induced by SSRI which can be reversible or irreversible.