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Atypical Antipsychotic-Induced Akathisia with Depression: Therapeutic Role of Mirtazapine

Senior Resident, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India

Prabha S Chandra, MD MRCPsych

Additional Professor, Department of Psychiatry, National Institute of Mental Health and Neurosciences

Santosh K Chaturvedi, MD MRCPsych

Professor, Department of Psychiatry, National Institute of Mental Health and Neurosciences

Santosh C Prabhu, MD

Senior Resident, Department of Psychiatry, National Institute of Mental Health and Neurosciences

Arun Gupta, MBBS

Junior Resident, Department of Psychiatry, National Institute of Mental Health and Neurosciences

Reprints: Dr. Ranjan, S-4, Kabini Hostel, National Institute of Mental Health and Neurosciences, Hosur Rd., Bangalore, India PIN-560029, fax 00 91-80-26564830, esarsingh{at}yahoo.co.in

OBJECTIVE: To investigate the efficacy of mirtazapine in treating akathisia caused by risperidone and olanzapine, as well as its use in alleviating comorbid depressive disorder.

CASE SUMMARIES: Five patients with diagnoses varying from schizophrenia, delusional disorder, and bipolar disorder developed akathisia while on treatment with olanzapine and risperidone. The likelihood that risperidone and olanzapine had induced akathisia in all patients was rated probable according to the Naranjo probability scale. Four of these patients were also found to be depressed. The akathisia was successfully treated with mirtazapine, and 3 of the 4 depressed patients improved with mirtazapine treatment. Use of mirtazapine did not result in any adverse effect.

DISCUSSION: Mirtazapine is a potent antagonist of central ₂ auto- and hetero-adrenergic receptors, as well as an antagonist of 5-HT_2A/2C, 5-HT₃, and histaminergic H₁ postsynaptic receptors. The efficacy of mirtazapine in treatment of akathisia may result from its antagonist property at the H₁ receptors and its dopaminergic activity in frontal cortex. The use of mirtazapine offers advantages over other antiakathisia drugs in its better adverse effect profile, as well as its ability to treat coexisting depression.

CONCLUSIONS: Mirtazapine is efficacious in treating atypical antipsychotic-induced akathisia. It may be a good option, particularly in patients with coexisting depression.

Key Words: akathisia, depression, mirtazapine, olanzapine, risperidone

Published Online, March 28, 2006. www.theannals.com, DOI 10.1345/aph.1G561

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