(#59) A Literature Review of SSRI-Induced Akathisia and its Potential Role in Suicidality

Abstract: Objectives: This review aims to provide an overview of SSRI-induced akathisia, examining its prevalence, underlying mechanisms, and potential role in increasing suicidality. Methods: A systematic review was conducted appropriately combining pertinent search terms on PubMed, APA PsycInfo and the Cochrane Library databases, with a preference for articles published within the last 5 years. Results: The review estimated that approximately 29.5% of patients who developed extrapyramidal symptoms (EPS) experienced SSRI-induced akathisia. This prevalence is higher than previously recognized, with estimates ranging from 5% to 25% depending on the population and specific SSRI. The likelihood of developing akathisia was greater in patients with a history of neuroleptic use or previous EPS. Risk was notably higher when SSRIs were combined with antipsychotics, compared to antipsychotics alone. Prompt recognition and management of akathisia are crucial to reduce its impact on patient outcomes, including adherence to antidepressant therapy and the potential for increased suicidality. Discussion: While the exact pathophysiology of akathisia remains unclear, evidence suggests a role for interactions between serotonin and dopamine systems. A major concern is the potential link between SSRI-induced akathisia and suicidality. Akathisia has been identified as a risk factor for suicidal ideation, and SSRIs, particularly upon initiation, may heighten this risk. Conclusion: Akathisia should be assessed on a spectrum. Individuals experiencing suicidal ideation shortly after starting SSRI treatment should be evaluated for underlying akathisia, even if minimal. Future research should focus on identifying akathisia in patients newly started on SSRIs to better understand and manage this condition.Short Description: Selective serotonin reuptake inhibitors (SSRIs) are widely prescribed for various psychiatric disorders in both adults and children. While generally well-tolerated, SSRIs can occasionally induce akathisiaóa movement disorder characterized by an inner sense of restlessness and an inability to remain still. This condition can significantly affect patient adherence to treatment and overall quality of life, potentially exacerbating psychiatric symptoms and increasing the risk of suicidal ideation.Name of Sponsoring Organization(s): N/A