Oromandibular dystonia associated with fluoxetine

A 66 year old patient with major depression treated with fluoxetine developed persistent oromandibular dystonia and mild akathisia. She improved significantly after discontinuation of the drug and treatment with biperiden. The temporal relationship between the use of fluoxetine and the occurrence of dystonia and akathisia suggests that fluoxetine may have induced tardive dystonia in this patient possibly due to a serotonergically mediated inhibition of striatal dopaminergic neurotransmission. We believe that this is the first reported case of persistent or tardive dystonia associated with fluoxetine treatment.