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November 22, 2004
mirtazapine to help with akathisia?
Efficacy of Low-Dose Mirtazapine in Neuroleptic-Induced Akathisia: A Double-Blind Randomized Placebo-Controlled Pilot Study
Poyurovsky, Michael MD; Epshtein, Svetlana MD; Fuchs, Camil PhD; Schneidman, Michael MD; Weizman, Ronit MD; Weizman, Abraham MD
Journal of Clinical Psychopharmacology: Volume 23(3) June 2003 pp 305-308
Antipsychotic medications are very useful in the treatment of psychosis and schizophrenia, but they have numerous side effects that need to be watched for and treated. While the side effects are generally manageable, it is important to observe and know when they need to be treated. One of the more distressing side effects that can occur, often near the beginning of antipsychotic treatment, is akathisia. Akathisia is a state of severe restlessness in which people feel as though they are “coming out of their skin.” This is more than just feeling that one can’t keep still, it is uncontrollable and incredibly disturbing. Akathisia has been blamed for suicides in which people feel that they just unable to control their bodies from the severe restlessness. Akathisia is a side effect of other psychiatric medications including antidepressants most significantly.
There are several treatments that are used for akathisia. The use of beta blockers (propranaolol, metoprolol and atenolol in particular) have been shown to have benefit in slowing people down. Other drugs, like the anticholinergics (like benztropine or Cogentin). Mirtazapine is a unique drug that acts at many different receptors for neurotransmitters (the chemicals that create activity in brain cells.) It is used typically for depression and has main side effects of weight gain and sedation. In this protocol, sedation was noted, but weight gain was not a problem because the treatment was only for five days.
In this study, the authors looked at 26 people who had akathisia induced by their antipsychotic medications. Patients were either treated with placebo or mirtazapine (randomly assigned, and “double-blind” meaning that neither the patients nor the raters knew who was receiving which) for five days. A placebo was used to identify if there was any placebo effect in which someone improves because of the minds ability to make people better because they think they are on active medication and to see if the actual medication is more powerful than that effect.
The authors found that mirtazapine was effective in the treatment of akathisia induced by antipsychotics. In this protocol, sedation was noted as a side effect with the mirtazapine, but weight gain was not a problem because the treatment was only for five days. 53% of the patients’ akathisia improved which is higher than is generally been reported with the other treatments mentioned above. However, it is impossible to directly compare results unless part of the same study, but it suggests that mirtazapine is at least as effective as other known treatments. The authors also noticed a small improvement in other movement related side effects (EPS) that can be seen with antipsychotics, but they were unable to say if that was clinically significant, but may be worth looking at in the future.Posted by Jacob at November 22, 2004 12:24 AM | TrackBack