Increased Anxiety, Akathisia, and Suicidal Thoughts in Patients with Mood Disorder on Aripiprazole and Lamotrigine

Risk factors for suicidal behavior/ideation and hostility/aggression in patients with bipolar disorders: An analysis using the Japanese Adverse Drug Event Report database

The present study attempted to identify risk factors for suicidality and hostility/aggression in patients with bipolar disorders. Data on 3521 patients were extracted from the Japanese Adverse Drug Event Report (JADER) database. There were 134 reports regarding suicidal behavior/ideation, and 129 patients were judged to have it. Standardized Medical Dictionary for Regulatory Activities queries indicated that 248 adverse drug events pertained to hostility/aggression, and 218 patients were considered to show hostility/aggression. A multiple logistic regression analysis revealed the association of the risk for suicidal behavior/ideation with bipolar II disorder [adjusted odds ratio (aOR): 4.55, 95% confidence interval (CI): 1.90-10.9], male sex (aOR: 1.23, 95% CI: 1.02-1.48), age <50 years (aOR: 1.75, 95% CI: 1.43-2.15), the administration of aripiprazole (aOR: 1.27, 95% CI: 1.00-1.60), and akathisia (aOR: 3.05, 95% CI: 1.80-5.18), while lithium carbonate decreased its odds (aOR: 0.664, 95% CI: 0.537-0.821). The risk of hostility/aggression was associated with male sex (aOR: 1.22, 95% CI: 1.06-1.40), lithium carbonate (aOR: 0.823, 95% CI: 0.710-0.953), and carbamazepine (aOR: 0.693, 95% CI: 0.500-0.961). No association between suicidal behavior/ideation and hostility/aggression was recognized. The present study proposes factors related with suicidal behavior/ideation and hostility/aggression in patients with bipolar disorders using the JADER database. Lithium carbonate appeared to decrease the risks of suicidal behavior/ideation and hostility/aggression in patients with bipolar disorders, and akathisia may be associated with the former risk. Further studies are required to evaluate the identified signals.

Dopamine-receptor blocking agent-associated akathisia: a summary of current understanding and proposal for a rational approach to treatment

Dopamine-receptor blocking agent-associated akathisia (DRBA-A) is an adverse effect that can significantly limit the use of these important medications for the treatment of a variety of psychiatric diseases, yet there is no unifying theory regarding its pathophysiology. This knowledge gap limits clinicians' ability to effectively manage DRBA-A and mitigate negative outcomes in an already vulnerable patient population. Based on a review of the current literature on the subject, it is hypothesized that dopaminergic and noradrenergic signaling is perturbed in DRBA-A. Accordingly, it is proposed that the optimal agent to manage this extrapyramidal symptom should increase dopamine signaling in the affected areas of the brain and counteract compensatory noradrenergic signaling via antagonism of adrenergic or serotonergic receptors.

Revisiting Antipsychotic-induced Akathisia: Current Issues and Prospective Challenges

BACKGROUND

Akathisia continues to be a significant challenge in current neurological and psychiatric practice. Prompt and accurate detection is often difficult and there is a lack of consensus concerning the neurobiological basis of akathisia. No definitive treatment has been established for akathisia despite numerous preclinical and clinical studies.] Method: We reviewed antipsychotic-induced akathisia including its clinical presentation, proposed underlying pathophysiology, current and under investigation therapeutic strategies.

CONCLUSION

Despite the initial promise that second generation antipsychotics would be devoid of akathisia effects, this has not been confirmed. Currently, there are limited therapeutic options for the clinical practice and the evidence supporting the most widely used treatments (beta blockers, anticholinergic drugs) is still absent or inconsistent.