Role of mirtazapine in the treatment of antipsychotic-induced akathisia.

Abstract

OBJECTIVE:

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

DATA SOURCES:

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

STUDY SELECTION AND DATA EXTRACTION:

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

DATA SYNTHESIS:

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.

• Authors: Robin Hieber, Timothy Dellenbaugh, Leigh Anne Nelson
• Journal: The Annals of pharmacotherapy (Ann Pharmacother) Vol. 42 Issue 6 Pg. 841-6 (Jun 2008) ISSN: 1542-6270 [Electronic] United States
• PMID: 18460588 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Adrenergic alpha-Antagonists
• Adrenergic beta-Antagonists
• Antipsychotic Agents
• Receptors, Serotonin
• Serotonin Antagonists
• Mianserin
• Propranolol
• Mirtazapine

Topics

• Adrenergic alpha-Antagonists (adverse effects, pharmacology, therapeutic use)
• Adrenergic beta-Antagonists (adverse effects, therapeutic use)
• Akathisia, Drug-Induced (drug therapy, etiology)
• Antipsychotic Agents (adverse effects)
• Clinical Trials as Topic
• Humans
• Mianserin (adverse effects, analogs & derivatives, pharmacology, therapeutic use)
• Mirtazapine
• Propranolol (adverse effects, therapeutic use)
• Receptors, Serotonin (drug effects)
• Serotonin Antagonists (adverse effects, pharmacology, therapeutic use)