Bupropion-Induced Acute Dystonia

Medication-induced acute dystonias are characterizedby prolonged muscle contraction, frequently present-ing with marked head (commonly oral–buccal) and neck muscle spasm with occasional jaw clenching, bruxism, and temporomandibular joint (TMJ) syndrome.1,2 The patho-physiology of acute dystonia is poorly understood. Symp-toms usually occur within hours to several days of starting, increasing, or decreasing the dose of a medication; severity usually decreases with rest and relaxation. We report a pa-tient who developed acute head and neck dystonia while being treated with bupropion and buspirone. The dystonia did not recur during buspirone rechallenge, but did present when the bupropion rechallenge dosage was increased from 150 mg sustained-release (SR) once a day to 150 mg SR twice a day. Case Report A 44-year-old white man, taking no prescribed or over-the-counter medications, with no significant medical history other than chronic low-back pain and tension headaches, presented to the mental health clini