Mirtazapine for Akathisia

Its efficacy might equal that of propranolol, possibly with fewer adverse effects.

Propranolol is generally considered a first-line treatment for akathisia induced by antipsychotic drugs, despite significant side effects and limited research supporting its efficacy. Because of preliminary observations that drugs with 5-HT_2A antagonist properties, such as cyproheptadine, are useful for akathisia, researchers in Israel studied the potential usefulness of mirtazapine, which antagonizes 5-HT_2A (as well as 5-HT₃ and adrenergic α2) receptors.

In a 7-day, double-blind trial, 90 patients with psychosis (mostly schizophrenia) and akathisia who were taking neuroleptics with or without other medications were randomly assigned to take mirtazapine (15 mg/day), propranolol (gradually increased to 40 mg twice daily), or placebo. All pati…

Reviewing Author

Steven Dubovsky, MD