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kfedouloff
Site Admin
Joined: 10 Sep 2003
Posts: 2181
Location: London
Sun May 22, 2005 6:54 am
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| SSRIs - Useful information about Akathisia |
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This information about articles on Akathisia has been provided by new forum member One Small Voice.
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Extracts of articles, whole articles at the URL at the top of each one.
1) http://www.cmdg.org/Movement_/drug/Akathesia/akathesia.htm
Managing antipsychotic-induced
acute and chronic akathisia
by
Miller CH, Fleischhacker WW
Department of Biological Psychiatry,
Innsbruck University Clinics Innsbruck,
Austria
Drug Saf 2000 Jan; 22(1):73-81
"...Since akathisia is a drug-induced adverse effect, optimal management involves its prevention rather than treatment....
...Based on the available literature, propranolol or other lipophilic beta-blockers seem to be the most consistently effective treatment for acute akathisia. There is nothing in the literature to guide a clinician when treatment with beta-blockers fails. Addition of benzodiazepines would appear to be a sensible next choice, especially if subjective distress persists. If all of these drugs are unsuccessful, amantadine or clonidine can be tried. Other agents that have been investigated include ritanserin, piracetam, valproic acid (sodium valproate) and tricyclic antidepressants. Evidence on the treatment of tardive akathisia is unsatisfactory..."
2) http://www.smj.org.uk/1001/aka1001.htm
"Scottish Medical Journal
Editorials/Comments
October 2001
AKATHISIA - A BRIEF REVIEW
D E Nelson
The Orchard Clinic
Royal Edinburgh Hospital
Morningside Terrace
Edinburgh
SMJ 2001;46: 133-134
...Akathisia is a common and unpleasant side effect of many psychotropic medications. Junior doctors are often slow to recognise it with consequences for the patient which include reduced compliance, exacerbation of psychotic symptoms and an increased risk of suicide and violence. The word akathisia comes from the Greek meaning literally “not to sit’ and was initially used by Haskovec in 19021 to refer to restless patients with hysteria and neurasthenia. Akathisia is a relatively common side effect of antipsychotic medication, although other drugs including antidepressants, metoclopramide, some calcium channel blockers, dopamine agonists, amphetamine and buspirone have all been shown to cause it. The symptoms consist of objective and subjective components. Subjectively there are symptoms of dysphoria including tension, panic, irritability and impatience...
...Associated severe anxiety may exacerbate psychosis and there is an increased risk of suicide and violence.4,5 Patients may not be able to distinguish akathisia from the ongoing symptoms of illness leading to despair.6 Patients are also at increased risk of developing tardive dyskinesia.7 It is important that akathisia is recognised and treated appropriately as misdiagnosis and a further increase in antipsychotic medication dosage may further exacerbate the condition...
...Studies have reported incidences ranging between 20 and 75%.1,3 Varying diagnostic approaches and differences in study populations account for much of the difference in incidence quoted. Gender does not seem to influence occurrence8 however it appears that acute akathisia and pseudoakathisia are more common in men and chronic akathisia is more common in women.2 There is no evidence any one race is particularly vulnerable.8 The risk is increased with higher potency drugs, higher dose, increased rate of dose escalation, the presence of extrapyramidal side effects (EPSEs), and parenteral administration.8,9 Age does not have a significant influence on the occurrence of acute akathisia.10
...Most authors refer to acute, tardive, chronic, withdrawal and pseudoakathisia.
Acute akathisia has an onset within hours or days, however some authors suggest the onset may be up to six months after an increase in dosage.7
Tardive akathisia is generally taken to mean akathisia of delayed onset (usually three months), not related to a recent change in drug or dose.10,11 It has been found to be significantly associated with tardive dyskinesia3 and some have proposed it to be a variant where the trunk and limbs are most affected. Activation procedures may help distiniguish between the two, for example finger tapping may increase symptoms in tardive dyskinesia but decrease the compulsion to move in akathisia.
Chronic akathisia usually refers to a persistence of symptoms for three months irrespective of the type of onset. 10,11
Withdrawal akathisia starts within six weeks of discontinuation or a significant dose decrease10 and
pseudoakathisia refers to a variant where there are objective symptoms but no subjective awareness or distress. These individuals tend to display more negative symptoms of psychotic illness...
Treatment
Optimal management is to prevent akathisia in the first instance. Patients should be forewarned of possible side effects and educated and reassured regarding these. Drugs which have been found to have some efficacy in the treatment of akathisia are outlined below...
[THEN IT GIVES A LIST OF TREATMENTS AND WHY THOSE DRUGS.]
3) http://www.drugawareness.org/Oldsite/healy.html
"...In the first clinical trial of its kind, Dr David Healy, director of the North Wales Department of Psychological Medicine at the University of Wales, gave Prozac to a volunteer group of mentally healthy adults and found even their behaviour was affected. He said: 'We can make healthy volunteers belligerent, fearful, suicidal, and even pose a risk to others.'
Healy says between one in 20 and one in 10 people who take Prozac can be affected by akathisia, whereby they become mentally restless or manic and lose all inhibitions about their actions 'People don't care about the consequences as you'd normally expect. They're not bothered about contemplating something they would usually be scared of,' he said..."
4) http://cat007.com/prozac.htm
" .........These Drugs [SSRIs] Alter Normal Brain Function
The explosive nature of these drugs is predictable. Studies show that they can cause a condition known as akathisia. Akathisia comes from the Greek word meaning "can't sit still," and refers to significant physical and mental agitation. Akathisia is to violence what a match is to gasoline. This condition has been reported in one out of 16 Prozac users, but its incidence is likely under-reported because Prozac also produces mania, hypomania, anxiety and restlessness, which are first cousins of akathisia."
5) http://www.socialaudit.org.uk/58048-DH.htm
"...Agitation/Akathisia
The evidence that SSRIs cause agitation comes directly from the clinical trial programs run by the market authorization holders, where approximately 5% of patients have dropped out because of drug induced agitation. Rates of drop-out for agitation are significantly greater than for placebo.
These clinical trial findings in depressed patients are corroborated by the results from healthy volunteer studies. In these phase 1 studies, the companies generally code akathisia to agitation or to hyperkinesis.
The critical point that emerges from these studies is how the market authorization holders can argue that their drugs do not lead to suicide against a background of their drugs causing agitation severe enough to lead to drop-outs from clinical trials at an up to 5% rate - in addition to all the less severe forms of agitation caused – and to agitation at an approximately 25% rate, occurring in a dose dependent fashion, in healthy volunteers. These data were all in place from the 1980s. In their early clinical trial program with Prozac, Lilly and their investigators specifically noted the emergence of akathisia/agitation and arranged for the concomitant administration of benzodiazepines to minimize this problem.
The fact that SSRIs cause akathisia has been conceded by company reviewers and by regulators and and a link between akathisia and suicide has been recognized by DSM-IV and company reviewers.
It has been long recognized in the medical community that akathisia can cause suicidality and this fact has been extensively documented in the medical literature.
The first emergence of this link came with reserpine, a psychotropic agent with comparable efficacy to SSRIs in trials for anxious depressives done in the 1950s (Davies and Shepherd 1955). This drug however led to suicide – and did so in the hypertensive patients to whom it was being given rather than in the psychiatric patients to whom it was also prescribed in higher doses (Healy and Savage 1998). It can be noted that despite causing suicide, reserpine is still prescribed to and can be effective for depressed patients (Price et al 1987).
Reserpine led to a state that could appear within hours or days of treatment commencing. This was characterised as follows:
"increased tenseness, restlessness, insomnia and a feeling of being very uncomfortable" (Achor et al 1955)...
...Sarwer-Foner and Ogle (1955) describe the case of CJ who on the first day of treatment reacted with marked anxiety and weeping and on the second day "felt so terrible with such marked panic at night that the medication was cancelled".
...With the advent of the SSRIs, evidence emerged regarding SSRI-induced akathisia and suicidality. A rechallenge study conducted by Rothschild and Locke in McLean Hospital brought this out clearly. The authors described Prozac-induced emergent suicidality associated with akathisia in several patients. In order to test whether the emergent suicidality was coincidental or was associated in a cause and effect way with Prozac, they withdrew Prozac, then re-administered it and all three cases after having made a previous serious suicide attempt on Prozac experienced the exact same effect on rechallenge.
"All three patients developed severe akathisia during treatment with fluoxetine and stated that the development of the akathisia made them feel suicidal and that it had precipitated their prior suicide attempts."
...A separate clinical literature suggests that akathisia can at times lead to emergence of suicidal ideation. Akathisia is defined as an ‘inner sense of restlessness’ and an ‘inability to sit still.’ Patients who experience this often give reports such as ‘I feel like I’m jumping out of my skin.’
As akathisia is a common side effect of neuroleptic medications, information regarding subjective response to akathisia exists primarily, although not exclusively, in the literature on schizophrenia. In 1974 Van Putten et al. noted that nine schizophrenics treated with high-potency neuroleptics showed ‘behavioral toxicity’ associated with akathisia.
Three of these patients developed de novo suicidal ideation. Schulte reported five cases of violent behavior, including completed suicides, as a result of akathisia in patients treated with neuroleptics. Shear et al. reported two cases of completed suicide by jumping in patients who the authors argue were suffering from akathisia. Drake and Ehrich also reported two cases of suicidal ideation secondary to akathisia. In one case the patient stated that he did not intend to die but that he would do anything to escape the intolerable feeling of restlessness. Drake and Ehrlich noted that these patients were unable to distinguish the akathisia from the ongoing symptoms of their psychiatric illness...
"Since the publication in 1989 of the article by Lipinski et al., reporting the occurrence of akathisia in five patients treated with [b]fluoxetine[/b][PROZAC], there have been several reports of akathisia associated with other selective serotonin reuptake inhibitors (SSRIs) such as sertraline, and, lately, paroxetine [SEROXAT]...
Suicidal ideation and behavior can sometimes emerge in persons with obsessive or panic features who take antidepressants or neuroleptics. Typical for such state is rapid development, impulsive and/or obsessive characteristic of suicidal ideation, an independence of the course of depression, severe tension and anxiety, an intense violence of suicidal fantasies and attempts, and their prompt disappearance after the discontinuation of the antidepressant... "
6) http://www.salon.com/health/feature/1999/07/19/zoloft/index1.html
"This agitation or akathisia drives a person into extreme states of irritability, anger, and frustration," Breggin continues. "People can become more depressed and more despairing; their impulse control loosens and they do stupid things. So the violent impulses that an ordinary person would control come pouring out or even appear for the first time.".....
7) http://emguidemaps.homestead.com/files/akathisia.html#akathisia
"this guidemap is only focused on acute drug-induced akathisia, which is a specific problem that emergency physicians frequently encounter, and the guidemap does not discuss chronic akathisia, which is a common problem in psychiatric patients taking long-term neuroleptic medications..."
NOTE THAT AKATHISIA CAN ALSO OCCUR IN WITHDRAWAL AS WELL AS WHILE TAKING SSRIs.
Coming off SSRIS cold turkey can BE MEDICALLY HAZARDOUS.
Advice on how to taper off SSRIs:
http://www.benzo.org.uk/healy.htm
"PROTOCOL FOR THE WITHDRAWAL
OF SSRI ANTIDEPRESSANTS
by Dr David Healy MD, FRCPsych
North Wales Department of Psychological Medicine,
Bangor, Gwynedd LL57 2PW, Wales, UK..." |
Babyblues
Full Member
Joined: 30 Sep 2004
Posts: 107
Sun May 22, 2005 9:16 am
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Hi Kfedouloff, thankyou for posting this useful information. Often side effects are misinterpreted for the already existing illness, such as in depression. ie: increased anxiety, and increased suicidal ideation and suicide attempts.
Doctors and health providers are often, too quick to give these drugs out for these conditions, but the side effects can be dangerous in some cases.
I wonder if there should be more contact with health providers, especially in the early phases of prescribing drugs to patients and monitoring there progress closely.
Educating patients of these risks, are important. Often I feel that doctors and health providers feel that this, information is of little use to the patient,
On the contary I feel that if the person is made aware of this information, it gives them a better informed choice, of possible side effects to be aware of.
I have had first hand experience on how dangerous these drugs can be, and would urge anyone to educate themselves thoroughly before taking prescription drugs.
If the side effects have escalated there symptoms, mood etc...
I would urge them to go back to there Doctor and explain this, keeping a well informed diary would be alot of help in showing mood changes.
We are responsible for what we put into our bodies, please just educate yourselves better on what you are taking, sometimes these drugs can worsen the problem and maybe therapy would be better to support the patient as opposed drugs.
Be aware and take care....
Babyblues xxxxxxxxxooooooo |
One Small Voice
Junior Member
Joined: 20 May 2005
Posts: 91
Mon May 23, 2005 9:21 am
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| Re: SSRIs - Useful information about Akathisia |
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quote:
Originally posted by kfedouloff
This information about articles on Akathisia...
Thank you for the pm - I tried to answer but haven't posted enough messages to qualify to reply, hence answering here. I understand, thank you and I hope the person gets through this, I was worried while away. |
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