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Translation of a-t 2020; 51: 16
 

SIDE EFFECTS

IMPULSE CONTROL DISORDERS WITH SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs)

Disorders of impulse control such as pathological gambling or compulsive shopping are known adverse effects of dopaminergic drugs to treat PARKINSON's disease such as pramipexole (SIFROL, generics; a-t 2005; 36: 84 and others) and have also been observed in the context of the use of atypical neuroleptics, particularly aripiprazole (ABILIFY, generics; a-t 2016; 47: 68 and others). In late 2019, our French sister journal La Revue Prescrire discribed a case of impuls control disorder in a 36-year-old man with anxiety disorder, who was treated with the selective serotonin reuptake inhibitor (SSRI) fluoxetine (e.g. FLUOXETIN ABZ). Three weeks after the start of treatment he developed compulsive shopping behaviour, causing financial difficulties. The disorder resolved within few days after discontinuing the antidepressant (1).

In the French pharmacovigilance system of adverse drug reactions, a regional French pharmacovigilance centre identified a further four reports of compulsive shopping in the context of SSRI-use, two with escitalopram (CIPRALEX, generics) and one each in patients taking fluoxetine and paroxetine (SEROXAT, generics) (2). The WHO database documents a total of 21 reports of compulsive shopping and 74 reports of gambling disorder in patients using SSRIs (3).

It is unclear how the behavioural disorders occur. Influences on serotonergic and dopaminergic neurotransmitter systems are under discussion. In the case of gambling disorder, there is an assumption that an increase in serotonergic activity in the brain of patients taking SSRIs can sustain "loss chasing" (2). In the context of gambling that is continuing to gamble to recover for losses (4). Long-term administration of SSRIs is also thought to increase the dopamine activity in certain areas of the brain, thereby increasing pathological gambling (2). On the other hand, up to 2009 the antidepressants were tested in several clinical trials for the treatment of gambling disorder and compulsive shopping with contradictory results (5,6).

An adverse drug reaction should be considered if disorders of impulse control such as compulsive shopping or gambling occur in patients using SSRIs. Patients should be informed about the risk. Impulse-control disorders have as yet not been mentioned in the German summaries of product characteristics of SSRIs, -Ed.

1La Revue Prescrire 2019; 39: 909
2LADHARI, C. et al.: Fundam. Clin. Pharmacol. 2019; 33 (Suppl. 1): 56 (Abstract PS1-034)
3WHO: VigiAccess, Accessed in February 2020; http://www.vigiaccess.org
4BIBBY, P.A.: Front. Psychol. 2016; 7: 3
5CHOI, S.W. et al.: Ann. Gen. Psychiatry 2017; 16: 23
6ABOUJAOUDE, E.: Curr. Pharm. Des. 2014; 20: 4021-5

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