Akathisia: Case Presentation and Review of Newer Treatment Agents

Abstract

Akathisia is a common and potentially debilitating adverse effect of many psychotropic agents. To a physician not specifically screening for this phenomenon, symptoms can appear similar to depression, anxiety, and/or psychosis. Further complicating matters, akathisia may also occur at different points during the treatment period with varying levels of severity in terms of patient distress. Treatment options have been limited by our somewhat poor understanding of akathisia’s neurological basis, but dopamine dysregulation is theorized to play a central role. Most pharmacotherapy regimens focus on beta-adrenergic antagonists (eg, propranolol, the current gold-standard), which are thought to affect noradrenergic inputs into the dopamine pathways of the brain. However, new research suggests a role for serotonin-based pharmacotherapy, particularly those affecting 5-HT2a/c receptors (eg, mirtazapine) in regulating dopamine. [ Psychiatr Ann . 2014; 44(8):391–396.]

Incidence of antiemetic‐induced akathisia in patients at a comprehensive cancer center

“…Novel approaches to the treatment of akathisia include the use of vitamin B6 and drugs that act directly on gamma‐aminobutyric acid receptors . Vitamin B6 serves as a cofactor in the synthesis of several neurotransmitters, such as dopamine, serotonin, and gamma‐aminobutyric acid, and its involvement with these neurotransmitters may be the reason for its efficacy in the treatment of akathisia . Head‐to‐head comparisons of the medications used to treat akathisia are necessary to identify the best treatment options.…”

“…9 Vitamin B6 serves as a cofactor in the synthesis of several neurotransmitters, such as dopamine, serotonin, and gamma-aminobutyric acid, and its involvement with these neurotransmitters may be the reason for its efficacy in the treatment of akathisia. 9 Head-to-head comparisons of the medications used to treat akathisia are necessary to identify the best treatment options. Treatment should aim to reduce the stress of emergency room visits, the cost of clinical services, and the suffering of patients with cancer.…”

Akathisia—A psychopharmacologic treatment “menu”

“…Surface portion is involved in unconditional defense behaviors. Based on these neural substrates, a psychopharmacological treatment "menu" is portrayed in Table 1 (Sethuram & Gedzior, 2014).…”

Acatisia inducida por fármacos no psicotrópicos: a propósito de un caso asociado a metoclopramida.

“…La fisiopatología de la acatisia aún es incierta y la disminución del tono dopaminérgico a nivel de ganglios basales sigue siendo reputada como el principal mecanismo fisiopatológico; en función a dicha hipótesis se ha reportado acatisia asociada a fármacos que bloquean los receptores D2 en ese nivel, sin que sean necesariamente psicotrópicos (7). Sin embargo, no todas las observaciones publicadas están en línea con la hipótesis de la deficiencia de dopamina; por ejemplo, no se ha encontrado una relación directa entre el parkinsonismo -el efecto secundario extrapiramidal más relacionado directamente con el antagonismo D2-y la acatisia (19).…”

“…El manejo terapéutico de la acatisia incluye el uso de estrategias como disminuir, cambiar o suspender fármacos (antipsicóticos, antieméticos), siempre que esto sea posible (3,7,8). Entre los fármacos de primera línea usados para el control de la acatisia están el propranolol (40-80 mg/día), mirtazapina (15 mg/día), ciproheptadina (8-16 mg/día) (8).…”