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Cited by 62Schizophrenia research and treatmentNeurotransmitter Receptor Influence on BehaviorTreatment of Major Depression

Efficacy of low-dose mirtazapine in neuroleptic-induced akathisia: a double-blind randomized placebo-controlled pilot study

Poyurovsky, Michael, Epshtein, Svetlana, Fuchs, Camil, Schneidman, Michael, Weizman, Ronit, Weizman, Abraham·2003·Journal of Clinical Psychopharmacology
DOI 10.1097/01.jcp.0000084027.22282.16
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Abstract

The nonselective serotonin (5-HT)-2A antagonists ritanserin, mianserin, and cyproheptadine were found efficacious in neuroleptic-induced akathisia (NIA). Mirtazapine is structurally and pharmacologically similar to mianserin, and the authors sought to determine its anti-NIA activity. Twenty-six neuroleptic-treated schizophrenic patients with DSM-IV diagnosis of NIA received add-on mirtazapine (15 mg/day) or placebo for 5 days in a double-blind design. Patients were assessed at baseline and days 3 and 5 with the Barnes Akathisia Scale (BAS), Positive and Negative Symptom Scale, Hamilton Rating Scale for Depression, and Simpson-Angus Scale for parkinsonism. Analysis of covariance with repeated measurements revealed significant group x time effects in favor of the mirtazapine group in both completers (n = 10 in each group) and intent-to-treat analysis (n = 13 in each group) for the BAS global subscale (F [1, 17] = 14.87, p = 0.001, and F [1, 23] = 13.24, p = 0.01, respectively) and objective subscale (F [1, 17] = 8.25, p = 0.011, and F [1, 23] = 7.35, p = 0.012, respectively) and borderline significant superiority for the BAS subjective subscale (F [1, 17] = 4.39, p = 0.051, and F [1, 23] = 4.12, p = 0.054, respectively) and distress subscale (F [1, 17] = 4.21, p = 0.056, and F [1, 23] = 3.80, p = 0.064, respectively). Significantly more mirtazapine-than placebo-treated patients (53.8% [7/13] vs. 7.7% [1/13], respectively; chi2 = 8.3, p = 0.004) met operational response criterion, a reduction of at least two points on the BAS global subscale. Mirtazapine treatment was associated with modest improvement of psychotic and parkinsonian symptoms. Mild sedation was the only side effect. Our study demonstrated that mirtazapine (15 mg/day) is an efficacious and well-tolerated therapeutic option in NIA. Marked 5HT2A/2C antagonistic activity of mirtazapine apparently accounts for its anti-NIA activity. The role of mirtazapine in the treatment of akathisia induced by atypical antipsychotic agents merits further investigation.

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Authors
Poyurovsky, M., Epshtein, S., Fuchs, C., Schneidman, M., Weizman, R., & Weizman, A.
Affiliations
  • Technion – Israel Institute of Technology (IL)
  • Tirat Carmel Mental Health Center (IL)
  • Tel Aviv University (IL)
  • Geha Mental Health Center (IL)
Corresponding author
  • Poyurovsky, Michael
  • Epshtein, Svetlana
  • Schneidman, Michael
ORCID
Venue
Journal of Clinical Psychopharmacology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2003-06
Volume
23
Issue
3
Pages
305-308
ISSN
0271-0749 (ISSN-L)
DOI
10.1097/01.jcp.0000084027.22282.16
OpenAlex
W2073098030
Cited by
62
References
10
Citations by year
2026: 1 · 2025: 1 · 2024: 5 · 2023: 1 · 2022: 1 · 2021: 2 · 2020: 3 · 2019: 2 · 2018: 3 · 2015: 5 · 2014: 1 · 2013: 4 · 2012: 2
FWCI
2.86
Type
journal article
Language
en
Open access
closed
Locations
  • Journal of Clinical Psychopharmacology (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute on Aging
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
Keywords
mirtazapine, neuroleptic-induced akathisia, schizophrenia, antipsychotic adverse effects, serotonin antagonists, mianserin, cyproheptadine, ritanserin, parkinsonism, depression, adjunctive therapy, placebo response
MeSH terms
Mirtazapine, Adult, Analysis of Variance, Double-Blind Method, Drug Therapy, Combination, Female, Humans, Male, Mianserin, Pilot Projects, Antipsychotic Agents, Chi-Square Distribution, Akathisia, Drug-Induced

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