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ARTICLES |
1 Clinical Pharmacist, Western Missouri Mental Health Center, Kansas City, MO
2 Director of Residency Training, Western Missouri Mental Health Center
3 Assistant Professor, School of Pharmacy, University of Missouri-Kansas City, Kansas City
* To whom correspondence should be addressed. E-mail: nelsonla{at}umkc.edu.
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Abstract |
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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-HT2A/5-HT2C 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 
-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.
Key Words: akathisia, extrapyramidal symptoms, mirtazapine.
Reprints: Dr. Nelson, Division of Pharmacy Practice, School of Pharmacy, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, MO 64108, fax 816/512-7478, nelsonla@umkc.edu
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