Reassessing mirtazapine and akathisia: A case report on its efficacy in treating severe, treatment-resistant akathisia and a review of the evidence.

Abstract

Antipsychotic-induced akathisia is a distressing movement disorder marked by intense internal restlessness and an urge to move. This report discusses a 44-year-old man with a diagnosis of schizophrenia who developed severe, treatment-resistant akathisia after taking haloperidol, a first-generation antipsychotic. Standard treatments for antipsychotic-induced akathisia, including benzodiazepines (Clonazepam) and benztropine, failed to alleviate the patient's persistent symptoms, causing considerable distress. However, the introduction of mirtazapine at a low dose of 15 mg led to substantial improvement, as indicated by a gradual reduction in the Barnes Akathisia Rating Scale score from 8 to 0 and improvements in mood, mobility, and daily activity participation. This case highlights the potential efficacy of mirtazapine in treating severe, resistant akathisia, adding to its established use in antipsychotic-induced akathisia management and contributing to the limited literature on its application in patients unresponsive to other conventional treatments.