Role of mirtazapine in the treatment of antipsychotic-induced akathisia.
OBJECTIVE
To evaluate the role of mirtazapine in the treatment of antipsychotic-induced akathisia.


METHODS
MEDLINE (1966-February 2008) and PsycINFO (1967-February 2008) were searched using the terms akathisia and mirtazapine. A bibliographic search was conducted as well.


METHODS
All English-language articles identified from the search were evaluated. All primary literature was included in the review.


RESULTS
Antipsychotic-induced akathisia can be difficult to manage and may respond to mirtazapine based on its antagonist activity at the serotonin 5-HT(2A)/5-HT(2C) receptors. Three case reports (N = 9 pts.), 1 placebo-controlled trial (N = 26), and 1 placebo- and propranolol-controlled study (N = 90) that evaluated mirtazapine for antipsychotic-induced akathisia have been published. Mirtazapine demonstrated a response rate of 53.8% compared with a 7.7% response rate for placebo, based on at least a 2-point reduction on the Barnes Akathisia Scale (global subscale; p = 0.004). Using the same criterion, mirtazapine and propranolol demonstrated efficacy based on response rates of 43.3% and 30.0% compared with placebo (6.7%; p = 0.0051). Mirtazapine was better tolerated than propranolol. In both studies, drowsiness was the most common adverse event associated with mirtazapine.


CONCLUSIONS
Mirtazapine may be considered a treatment option for antipsychotic-induced akathisia. It may be especially useful for patients with contraindications or intolerability to beta-blockers and for those with comorbid depression or negative symptoms. Additional studies should be conducted to provide further evidence of mirtazapine's effectiveness in treating akathisia.
Hieber
Robin
R
Western Missouri Mental Health Center, Kansas City, MO, USA.
Dellenbaugh
Timothy
T
Nelson
Leigh Anne
LA
D000317:Adrenergic alpha-Antagonists / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D017109:Akathisia, Drug-Induced / Q000188:drug therapy* / Q000209:etiology; D014150:Antipsychotic Agents / Q000009:adverse effects*; D002986:Clinical Trials as Topic; D006801:Humans; D008803:Mianserin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D000078785:Mirtazapine; D011433:Propranolol / Q000009:adverse effects / Q000627:therapeutic use; D011985:Receptors, Serotonin / Q000187:drug effects; D012702:Serotonin Antagonists / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use
D000317:Adrenergic alpha-Antagonists; D000319:Adrenergic beta-Antagonists; D014150:Antipsychotic Agents; D011985:Receptors, Serotonin; D012702:Serotonin Antagonists; D008803:Mianserin; D011433:Propranolol; D000078785:Mirtazapine