Abstract

Successful management of Haloperidol induced akathisia with cyproheptadine

Author(s): Karl Goodkim

Akathisia is a term used for motor restlessness along with subjective feelings of tension and discomfort. It requires both subjective and objective aspects and these behaviors are attributed to inner feelings of tension. It is due to antipsychotic drug exposure. Treatment involves lowering the dosage of the antipsychotic medications, adding propranolol, benzodiazepines like diazepam or clonazepam, clonidine, mirtazapine. Here we are presenting a case of akathisia which we found novel as the patient didn�??t respond to the forementioned conventional methods and developed adverse effects but responded only to cyproheptadine syrup. There should be a personalized treatment plan for akathisia, incorporating details like history, therapeutic response and side effects profile. Akathisia is a term used for motor restlessness along with subjective feelings of tension and discomfort. It requires both subjective and objective aspects and these behaviors are attributed to inner feelings of tension. Akathisia meaning �??Never to sit down�?� is a drug induced movement disorder which develops within first 4 weeks of starting or increasing the dose of antipsychotic medications or after decreasing the dose of antiparkinsonian drugs. Prevalence of Antipsychotic induced akathisia is 20%-75%. It is also reported with Selective Serotonin Reuptake Inhibitors where it is mediated by the serotonin agonism of the dopamine system. These symptoms should not be a part of any other psychiatric illness, neurological or a general medical condition. Cholinergic, adrenergic, serotonergic, dopamine pathways are implicated in the etiology of akathisia. This condition is often misdiagnosed as persistent anxiety or agitation or manic excitement. The two traditional methods involved in treatment are the change in antipsychotic regimen and addition of an anti-akathisia agent. Pharmacological regimens mainly focus on the role of beta adrenergic blockers like propranolol in the treatment of akathisia. Newer research focus on the role of 5HT 2A receptor mediators like mirtazapine, cyproheptadine. This activity is thought to counteract antipsychotic-induced dopamine D2 receptor blockade with subsequent enhancement in dopamine neurotransmission. Lack of response to conventional methods is common but developing adverse effects with most of the first line drugs but tolerating cyproheptadine alone is quite unusual.In india,we have comparative studies between cyproheptadine and other conventional methods there are not much case reports supporting the evidence of sole response to cyproheptadine alone.