Balance Control Improves Following Replacement of Paroxetine with Venlafaxine and Levodopa in a Case of Microvascular Dementia

Background

Postural instability is a concern in several neurologic conditions and also among the elderly. Dysfunction in serotonergic, noradrenergic, and dopaminergic pathways may be involved in the etiology of postural imbalance.

Objective

The objective of this case report was to quantify, using computerized posturography, substitution with venlafaxine, and later levodopa, in a suspected case of postural instability with paroxetine.

Case Summary

Presented is an 86-year-old woman with frequent falls and a Parkinson-like syndrome of the lower limbs secondary to microvascular dementia. Paroxetine was gradually discontinued and exchanged for venlafaxine, 37.5 mg twice daily. Before and after medication changes, static posturography was performed under eyes open and closed conditions. Following 3 months of venlafaxine, the patient showed significant improvement from baseline, however, venlafaxine was then reduced to 37.5 mg at bedtime. Six months later, levodopa was introduced and further improvement was observed. It is possible that venlafaxine, which maintains a more balanced affinity for serotonin and norepinephrine transporters, may have provided postural benefit. Decreased sedation secondary to venlafaxine reduction may have elicited further improvements in addition to the increased lower limb functionality observed with levodopa.

Conclusions

For patients on antidepressants, switching medications may be worthwhile in those with balance problems. The prudent addition of medications may also be an option.