Selective serotonin reuptake inhibitor-induced akathisia

Area of Science:

• Pharmacology
• Neuroscience
• Clinical Pharmacy

Background:

• Akathisia, characterized by inner restlessness, is a potential side effect of selective serotonin reuptake inhibitors (SSRIs).
• Recognizing akathisia is critical due to its significant patient burden and potential to induce suicidal ideations.

Purpose of the Study:

• To comprehensively review existing literature on akathisia induced by SSRIs.
• To identify key diagnostic factors, predisposing conditions, and treatment strategies for SSRI-induced akathisia.

Main Methods:

• A systematic literature search was conducted across multiple databases (Medline, PsychInfo, International Pharmaceutical Abstracts, Google Scholar).
• Search terms included akathisia, psychomotor agitation, and specific SSRIs (fluoxetine, fluvoxamine, sertraline, paroxetine, citalopram, escitalopram).
• Articles were selected if they explicitly mentioned akathisia, with case reports chosen if SSRIs were identified as causative or contributing agents.

Main Results:

• Akathisia can be identified through symptom assessment, evaluation of predisposing factors, and the use of the Barnes Akathisia Rating Scale (BARS).
• Predisposing factors include polypharmacy with akathisia-inducing drugs, recent SSRI dose titration, prior akathisia history, baseline psychiatric conditions, and brain trauma.
• Treatment options involve adding beta-blockers, benzodiazepines, or anticholinergic agents.

Conclusions:

• Pharmacists are well-positioned to identify akathisia by understanding its clinical presentation and risk factors.
• Thorough medication histories and the utilization of BARS can aid in early detection and management.
• Proactive identification and intervention by pharmacists can mitigate patient discomfort and enhance medication adherence.