Acute dystonia with concomitant use of amitriptyline and paroxetine

Amitriptyline and paroxetine are antidepressant agents useful for the treatment depressive disorders. Antidepressant induced extrapyramidal symptoms represent an under recognised but important clinical entity as it can adversely impact treatment adherence. Cases of acute dystonia have been reported with selective serotonin reuptake inhibitors but there are only few cases reporting dystonia on amitriptyline. To add to this literature, we report a case of middle aged female who developed dystonia on amitriptyline while already being treated with paroxetine. So, it is warranted to be aware of combination therapy's side effects.