Escitalopram-induced hypnic jerks: An overlooked side effect

Abstract

Background: Hypnic jerks, also known as sleep starts, are sudden, involuntary muscle contractions that occur during the transition from wakefulness to sleep. These typically benign but sometimes distressing movements have been linked to certain medications, particularly selective serotonin reuptake inhibitors (SSRIs). Cases: This article explores three cases of escitalopram-induced hypnic jerks. A 45-year-old female with major depressive disorder experienced sudden jerks after increasing her escitalopram dose from 10 mg to 15 mg, which improved after reducing the dose and adding clonazepam. A 28-year-old male with adjustment disorder developed involuntary jerks after starting escitalopram 10 mg, with symptoms improving upon clonazepam addition without altering the SSRI dose. A 31-year-old female switched from venlafaxine to escitalopram 10 mg and developed jerky head movements during sleep, which resolved after discontinuing escitalopram and starting fluoxetine. Implications: These cases suggest that escitalopram-induced hypnic jerks, though rare, may arise due to serotonin-related motor control changes during sleep. Recognizing these movements as benign can help alleviate patient anxiety. Clinicians should monitor for such symptoms, educate patients, and consider dose modifications or adjunctive treatments like clonazepam to improve sleep quality and overall well-being.