Treatment of neuroleptic-induced akathisia with the 5-HT2A antagonist trazodone.
Akathisia is a common and distressful extrapyramidal adverse side effect usually resulting from the use of antipsychotic medications. Early management of akathisia is important because it may be associated with poor treatment response and medication noncompliance. Unfortunately many patients fail to respond to standard management of akathisia. In addition to dopaminergic mechanisms, it has been hypothesized that serotonin may play a prominent role in the pathophysiology of akathisia. Trazodone is an antidepressant agent demonstrating prominent serotonergic antagonistic properties. This open-label pilot study investigates the efficacy of trazodone in the management of akathisia. Nine female patients with a score of at least "mild akathisia" on the Barnes Akathisia Scale, and receiving a stable dose of antipsychotic medication, were administered trazodone, titrated up to a dosage of 100 mg/day over a period of 5 days. The patients demonstrated marked improvement in symptoms of akathisia. In addition, some improvement was noted in symptomatology of anxiety, depression, and psychosis. These observations suggest the use of trazodone as a beneficial and relatively safe medication for the treatment of antipsychotic medication-induced akathisia. Further study in the context of a double-blind, placebo-controlled trial is mandated to substantiate these preliminary findings.
Stryjer
Rafael
R
Beer Yaakov Mental Health Center, Israel. raels@post.tau.ac.il
Strous
Rael D
RD
Bar
Faina
F
Poyurovsky
Michael
M
Weizman
Abraham
A
Kotler
Moshe
M
D000328:Adult; D017109:Akathisia, Drug-Induced / Q000188:drug therapy*; D014150:Antipsychotic Agents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010865:Pilot Projects; D011618:Psychotic Disorders / Q000188:drug therapy; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D014196:Trazodone / Q000627:therapeutic use*; D016896:Treatment Outcome
D014150:Antipsychotic Agents; D017367:Selective Serotonin Reuptake Inhibitors; D014196:Trazodone