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.