Table 2

Reports on the efficacy of serotonergic agents in patients with neuroleptic-induced akathisia (NIA)

Reference Study design Serotonergic agent n Treatment duration (days) Dose (mg/day) Outcome measures Results
HAS, Hillside Akathisia Scale; CGI, Clinical Global Impression; BAS, Barnes Akathisia Scale; BPRS, Brief Psychiatric Rating Scale; HRSD, Hamilton Rating Scale for Depression; SAS, Simpson and Angus Scale for extrapyramidal side-effects; mLAS, modified Leeds Anxiety Scale.
5-HT2a antagonists
Miller et al, 1990 Open trial Ritanserin 10 3 5-20 HAS, CGI 8/10 improved
Miller et al, 1992 Case reports Ritanserin 3 3 20 HAS, CGI Resistant NIA, 3/3 improved
Weiss et al, 1995 Open trial Cyproheptadine 17 4 16 HAS, BPRS, HRSD, AIMS 15/17 improved; 6/17 complete disappearance of NIA
Fischel et al (2001) Double-blind trial v. propanolol Cyproheptadine 18 cyproheptadine 12 propanolol 4 16 BAS, BPRS, SAS Both cyproheptadine and propanolol were efficacious (40 and 42% decrease in BAS, respectively)
Poyurovsky et al, 1998 Open trial Mianserin 16 14 15 BAS, SAS Improvement in all three BAS sub-scales
Poyurovsky et al, 1999 Double blind trial v. placebo Mianserin 15 mianserin 15 placebo 5 15 BAS, SAS, BPRS, mLAS, HRSD 14/15 of mianserin group improved v. 5/11 in placebo group
Poyurovsky & Weizman (2001) Case report Mirtazapine 1 4 15 BAS, SAS Improved
5-HT1 partial agonists
D'Mello et al, 1989 Case reports Buspirone 3 Not reported 10-15 3/3 improved
Poyurovsky & Weizman, 1997 Open trial Buspirone 10 4 10-30 BAS, SAS 2/10 improved, 6/10 unchanged, 2/10 worse
5-HT3 antagonist
Poyurovsky & Weizman, 1999 Open trial Granisetron 10 4 2 BAS, SAS, mLAS, BPRS, HRSD 3/10 dropouts, 5/10 unchanged, 2/10 improved