Treatment of tardive akathisia

Tardive akathisia (TA) is characterized by a subjective sense of motor restlessness associated with objective motor movements that occur in the setting of chronic therapy with dopamine receptor blocking agents (DBA). Acute akathisia typically occurs in the setting of initial therapy or with an increase in dose of DBA and is often quite responsive to lowering the dose or stopping the DBA or adding β-adrenergic blocking agents and benzodiazepines. By contrast, TA is often very difficult to treat and may emerge in the setting of DBA withdrawal. There are currently no FDA-approved therapies or significant randomized clinical trials looking at treatments for TA, but there are some published case series of potentially beneficial therapies. These medications include anticholinergics, β-adrenergic blocking agents, clonazepam, clonidine, dopamine agonists, and dopamine-depleting agents such as reserpine and tetrabenazine, pregabalin, mirtazapine, and zolpidem. A summary table of potential therapies is provided.