Is history of depression a contraindication to treatment with tetrabenazine?

OBJECTIVE

To determine whether a history of depression predisposes hyperkinetic patients treated with tetrabenazine (TBZ) to a recurrence or worsening of this symptom.

METHODS

We retrospectively reviewed the charts of 518 patients treated with TBZ to determine the frequency of depression and other adverse events. Charts were screened for the preexistence, development, or exacerbation of depression during the course of treatment.

RESULTS

The most common adverse events related to TBZ were somnolence (27.4%), depression (15.1%), parkinsonism (11.8%), and akathisia (8.9%); 78 patients (15.1%) experienced depression for the first time or an exacerbation of existing depression. Of those patients with no history of depression, 28 (11.4%) of 246 were newly diagnosed with depression. Patients with a documented history of depression experienced a significantly higher rate of worsening in 50 (18.4%) of 272 cases (P = 0.03). However, patients with a history of depression experienced more improvement of their hyperkinesia compared to those without a history of depression (P < 0.01).

CONCLUSIONS

Depression, an adverse event of TBZ, is more likely to occur or worsen in patients with a preexisting history of depression.