Atypical Antipsychotic–Induced Akathisia with Depression: Therapeutic Role of Mirtazapine

Abstract

Mirtazapine is efficacious in treating atypical antipsychotic-induced akathisia. It may be a good option, particularly in patients with coexisting depression.

Dopamine-receptor blocking agent-associated akathisia: a summary of current understanding and proposal for a rational approach to treatment

“… 101 Comparative studies have shown cyproheptadine, zolmitriptan, and vitamin B6 produce similar levels of DRBA-A symptom reduction when compared with a range of doses (40–120 mg/day) of propranolol. 102 – 104 Serotonin 5-HT 2A receptor antagonists, such as mirtazapine, 105 – 110 trazodone, 111 fluvoxamine, 112 zolmitriptan, 103 mianserin, 113 and cyproheptadine, 102 represent another class of treatments for DRBA-A. 114 Blocking this receptor likely plays a role in reducing symptoms by increasing downstream dopamine signaling in areas of the brain affected by DRBAs.…”

Mirtazapine for antipsychotic-induced acute akathisia: a systematic review and meta-analysis of randomized placebo-controlled trials

“…Improvement was noted after 2–7 days, and only case 3 could be weaned off mirtazapine over a month without recurrence, whereas case 1 could be maintained on 3.75 mg dose. In another case series ( n = 5), Ranjan and colleagues reported reduction in AIAA with the addition of 15 mg mirtazapine, with an additional benefit for depressive symptoms [Ranjan et al . 2006].…”

“…Both the Poyurovsky studies were also identified through a PUBMED search [Poyurovsky et al 2003[Poyurovsky et al , 2006. Four studies were excluded as they were case reports or case series [Poyurovsky and Weizman, 2001a;Wilson, 2005;Ranjan et al 2006;Poyurovsky et al 2014]. In a case study, Poyurovsky and Weizman observed a reduction of AIAA (that did not improve with trial of biperiden 4 mg twice daily for 5 days, and subsequently diazepam 10 mg for 3 days) after the second day, with the addition of a morning dose of 15 mg mirtazapine [Poyurovsky and Weizman, 2001a].…”

“…Common side effects include sedation, weight gain and increased appetite. Recent studies have shown that mirtazapine is useful for the treatment of AIAA [Poyurovsky and Weizman, 2001a;Wilson, 2005;Ranjan et al 2006;Poyurovsky et al 2003Poyurovsky et al , 2006Poyurovsky et al , 2014, although a few case reports of akathisia, both acute and tardive, induced by mirtazapine have been reported [Girishchandra et al 2002;Gulsun and Doruk, 2008;Ozyildirim and Kosecioglu, 2009;Markoula et al 2010]. As the effect of first-line agents for AIAA is variable, we reviewed existing literature to identify if enough evidence is available for mirtazapine.…”

The Tolerability of Mirtazapine Augmentation in Schizophrenic Patients Treated with Risperidone: A Preliminary Randomized Placebo-controlled Trial

“…A few studies7,17) mentioned that mirtazapine is efficacious in treating atypical antipsychotic (olanzapine, risperidone, aripiprazole)-induced akathisia, particularly in patients with coexisting depression. This discrepancy with our study may be due to the presence of comorbid depression in patients (our study excluded clinically depressive patients).…”