Rabbit Syndrome Likely Induced by Escitalopram: A Case Report

Area of Science:

• Neuroscience
• Psychiatry
• Pharmacology

Background:

• Reports of rabbit syndrome (RS) have emerged unrelated to antipsychotic medications.
• Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), are increasingly implicated in causing RS.
• The mechanism is hypothesized to involve SSRI-induced serotonergic inhibition of the dopaminergic system.

Observation:

• A 35-year-old male with moderate depressive disorder was prescribed escitalopram and clonazepam.
• Three months post-initiation, the patient developed perioral trembling, exacerbated by focused tasks.
• Brain CT scan results were normal, ruling out structural abnormalities.

Findings:

• The patient was diagnosed with drug-induced rabbit syndrome.
• Discontinuation of escitalopram and initiation of trihexyphenidyl resulted in complete symptom resolution within 20 days.
• Subsequent irritability was managed with sodium valproate.

Implications:

• Escitalopram can induce rabbit syndrome, similar to dopamine-blocking antipsychotic drugs.
• This case underscores the importance of considering SSRIs in the differential diagnosis of drug-induced movement disorders.
• Management may involve medication withdrawal and symptomatic treatment with anticholinergic agents or other suitable medications.