Akathisia—A psychopharmacologic treatment “menu”

Dopamine-receptor blocking agent-associated akathisia (DRBA-A) is an adverse effect that can significantly limit the use of these important medications for the treatment of a variety of psychiatric diseases, yet there is no unifying theory regarding its pathophysiology. This knowledge gap limits clinicians’ ability to effectively manage DRBA-A and mitigate negative outcomes in an already vulnerable patient population. Based on a review of the current literature on the subject, it is hypothesized that dopaminergic and noradrenergic signaling is perturbed in DRBA-A. Accordingly, it is proposed that the optimal agent to manage this extrapyramidal symptom should increase dopamine signaling in the affected areas of the brain and counteract compensatory noradrenergic signaling via antagonism of adrenergic or serotonergic receptors.

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“…These agents should be used with caution, however, as dopamine agonism carries with it the risk of exacerbating psychotic symptoms. 32 …”

Section: Discussionmentioning

confidence: 99%

Dopamine-receptor blocking agent-associated akathisia: a summary of current understanding and proposal for a rational approach to treatment

Schwartz

McAllister

Caudle

2020

Therapeutic Advances in Psychopharmacology

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“…Neurobiological underpinnings of akathisia include D2 blockade, 5HT2A overstimulation, GABA deficiency, M1 Cholinergic overactivity, and, noradrenergic overactivity. 12 Cyproheptadine, by blocking 5HT2A and M1 receptors can be an attractive option for antipsychotic-induced akathisia. 13 Antidepressants, mirtazapine and mianserin, have been used similarly.…”

Section: Akathisiamentioning

confidence: 99%

Cyproheptadine: a psychopharmacological treasure trove?

Badr

Naguy

2021

CNS Spectr.

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“…Lipophilic beta-adrenergic antagonists, such as propranolol, are one of the most well-tolerated and consistently effective therapeutic agents for akathisia. [35][36][37]…”

Section: Akathisiamentioning

confidence: 99%

Adjuvant Therapy With β-Adrenergic Blockers in Psychiatry

Naguy

Moodliar

2020

American Journal of Therapeutics

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Beta-adrenergic blockers (b-blockers), notably propranolol, are commonly deployed in psychiatric practice to address a multitude of clinical indications. 1 These include, inter alia, performance anxiety, posttraumatic stress disorder, schizophrenia, mood disorders, neurodevelopmental disorders [autism spectrum disorder (ASD), ID, Tourette syndrome [TS], and attention-deficit/hyperactivity disorder], episodic dyscontrol, lithium-induced tremors, clozapine-induced tachycardia, akathisia, alcohol detoxification, organic brain syndrome, dementia, and traumatic brain injury (TBI). Here, we brief the clinical use of b-blockers in such diverse indications while examining the extant evidence. It should be borne in mind that all these are off-label uses, and b-blockers are currently not FDA-approved for any psychiatric indication. Moreover, trend of clinical use seems to have fallen into disfavor in the 21st century with the rampant introduction of newer more nuanced psychotropic agents on the market. A major setback is the bulk of literature on psychiatric uses of b-blockers, that dates back to the eighties when its use was pretty popular but sorely where methodological flaws have crept into these studies. Cautious interpretation is then highly warranted.b-blockers are competitive antagonists of norepinephrine (NE) and epinephrine at b-adrenoceptors. They are peripherally sympatholytics. They lack direct sedation or abuse potential. They differ regarding their selectivity (eg, propranolol is nonselective while atenolol is more b 1 antagonist), lipophilicity (eg, propranolol has high lipophilicity while atenolol has lower lipophilicity), half-lives (eg, propranolol 3-6 hr and atenolol 6-9 hr), and route of elimination (eg, propranolol has hepatic while atenolol has renal clearance). For those with COPD, a more selective b 1 antagonist, for example, atenolol, is preferred. Use is also cautioned in diabetics as b-blockers could mask hypoglycemia. It should be withheld if blood pressure is less than 90/60 or heart rate is below 55 bpm.

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Akathisia—A psychopharmacologic treatment “menu”

Cited by 5 publications

References 4 publications

Dopamine-receptor blocking agent-associated akathisia: a summary of current understanding and proposal for a rational approach to treatment

Dopamine-receptor blocking agent-associated akathisia: a summary of current understanding and proposal for a rational approach to treatment

Cyproheptadine: a psychopharmacological treasure trove?

Adjuvant Therapy With β-Adrenergic Blockers in Psychiatry

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