Skip to main content Accessibility help
×
Home

Detection and treatment of akathisia in advanced cancer patients during adjuvant analgesic therapy with tricyclic antidepressants: Case reports and review of the literature

Published online by Cambridge University Press:  25 October 2007

Hideki Onishi
Affiliation:
Department of Psycho-Oncology, Saitama Medical University, Saitama, Japan
Wataru Yamamoto
Affiliation:
Department of Clinical-Oncology, Saitama Medical University, Saitama, Japan
Makoto Wada
Affiliation:
Department of Psychiatry, Kyoto University School of Medicine, Kyoto, Japan
Tomomi Nishida
Affiliation:
Department of Psychiatry, Sakamoto Hospital, Sakamoto, Japan
Mei Wada
Affiliation:
Department of Clinical Psychology, Kitasato Medical University, Kitasato, Japan
Yu Sunagawa
Affiliation:
Department of Clinical-Oncology, Saitama Medical University, Saitama, Japan
Toshimichi Miya
Affiliation:
Department of Clinical-Oncology, Saitama Medical University, Saitama, Japan
Chiaki Kawanishi
Affiliation:
Department of Psychiatry, Yokohama City University, Yokohama, Japan
Masaru Narabayashi
Affiliation:
Department of Clinical-Oncology, Saitama Medical University, Saitama, Japan
Yasutsuna Sasaki
Affiliation:
Department of Clinical-Oncology, Saitama Medical University, Saitama, Japan
Corresponding
E-mail address:

Abstract

Objective:

There is substantial evidence that tricyclic antidepressants are effective in the management of chronic pain, including cancer pain. In oncological settings, these agents are used as adjuvant analgesic drugs. However, cases of akathisia due to tricyclic antidepressants used as adjuvant analgesic therapy have not previously been reported.

Case reports:

Two cancer patients experiencing chronic pain who were refractory to nonsteroidal anti-inflammatory drugs and opioids were prescribed amoxapine as an adjuvant analgesic therapy for neuropathic pain. These patients developed inner restlessness and restless physical movements after amoxapine was prescribed. Although symptoms were atypical, akathisia was suspected and discontinuation of amoxapine resolved the symptoms.

Results and significance of results:

Akathisia should be considered in patients receiving adjuvant analgesic therapy with tricyclic antidepressants. Early detection and appropriate treatment will relieve this distressing symptom. Restless movements involving parts of the body other than the legs may be the clue to the diagnosis.

Type
Case Report
Copyright
Copyright © Cambridge University Press 2007

Access options

Get access to the full version of this content by using one of the access options below.

References

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC: American Psychiatric Press.Google ScholarPubMed
Apiquian, R., Fresan, A., Ulloa, R.E., et al. (2005). Amoxapine as an atypical antipsychotic: A comparative study vs risperidone. Neuropsychopharmacology, 30, 22362244.CrossRefGoogle ScholarPubMed
Atbaşğlu, E.C., Schultz, S.K., & Andreasen, N.C. (2001). The relationship of akathisia with suicidality and depersonalization among patients with schizophrenia. Journal of Neuropsychiatry and Clinical Neurosciences, 13, 336341.CrossRefGoogle Scholar
Botney, M. & Fields, H.L. (1983). Amitriptyline potentiates morphine analgesia by a direct action on the central nervous system. Annals of Neurology, 13, 160164.CrossRefGoogle ScholarPubMed
Dolton, P.T. (1981). Amoxapine: A newly marketed tricyclic antidepressant. Psychatric Annals, 11, 379383.Google Scholar
Francis, J., Martin, D., & Kapoor, W.N. (1990). A prospective study of delirium in hospitalized elderly. JAMA, 263, 10971101.CrossRefGoogle ScholarPubMed
Gibb, W.R. & Lees, A.J. (1986). The clinical phenomenon of akathisia. Journal of Neurology Neurosurgery and Psychiatry, 49, 861866.CrossRefGoogle ScholarPubMed
Hamon, M., Gozlan, H., Bourgoin, S., et al. (1987). Opioid receptors and neuropeptides in the in the CNS in rats treated chronically with amoxapine or amitriptyline. Neuropharmacology, 26, 531539.CrossRefGoogle ScholarPubMed
Hirose, S. (2000). Restlessness of respiration as a manifestation of akathisia: Five case reports of respiratory akathisia. Journal of Clinical Psychiatry, 61, 737741.CrossRefGoogle ScholarPubMed
Hirose, S. (2003). The causes of underdiagnosing akathisia. Schizophrenia Bulletin, 29, 547558.CrossRefGoogle ScholarPubMed
Hsin-Tung, E. & Simpson, G.M. (2000). Medication-induced movement disorders. In Comprehensive Textbook of Psychiatry, 7th ed., Sadock, B. & Sadock, V.A. (eds.). Philadelphia: Lippincott Williams & Wilkins.Google Scholar
Khawam, E.A., Laurencic, G., & Malone, D.A. Jr. (2006). Side effects of antidepressants: An overview. Cleveland Clinic Journal of Medicine, 73, 351353.CrossRefGoogle ScholarPubMed
Krishnan, K.R.R., France, R.D., & Ellinwood, E.H. (1984). Tricyclic-induced akathia in patients taking conjugated estrogens. American Journal of Psychiatry, 141, 696697.Google ScholarPubMed
Magni, G., Conlon, P., & Arsie, D. (1987). Tricyclic antidepressants in the treatment of cancer pain: A review. Pharmacopyschiatry, 20, 160164.CrossRefGoogle ScholarPubMed
Portenoy, R.K. (2001). Adjuvant analgesics in pain management. In Oxford Textbook of Palliative Medicine, Doyle, D., Hanks, G.W.C., & MacDonald, N. (eds.), pp. 361390. Oxford, Oxford University Press.Google Scholar
Ratey, J.J. & Salzman, C. (1984). Recognizing and managing akathisia. Hospital Community Psychiatry, 35, 975977.Google ScholarPubMed
Rodgers, C. (1992). Extrapyramidal side effects of antiemetics presenting as psychiatric illness. General Hospital Psychiatry, 14, 192195.CrossRefGoogle ScholarPubMed
Sachdev, P. & Kruk, J. (1994). Clinical characteristics and predisposing factors in acute drug-induced akathisia. Archives of General Psychiatry, 51, 963974.CrossRefGoogle ScholarPubMed
Siris, S.G. (1985). Three cases of akathisia and “acting out.” Journal of Clinical Psychiatry, 46, 395397.Google ScholarPubMed
Shear, M.K., Frances, A., & Weiden, P. (1983). Suicide associated with akathisia and depot fluphenazine treatment. Journal of Clinical Psychopharmacology, 3, 235236.CrossRefGoogle ScholarPubMed
Walters, A.S., Hening, W., Chokroverty, S., et al. (1989). Restlessness of the arms as the principal manifestation of neuroleptic-induced akathisia. Journal of Neurology, 236, 435.CrossRefGoogle ScholarPubMed

Full text views

Full text views reflects PDF downloads, PDFs sent to Google Drive, Dropbox and Kindle and HTML full text views.

Total number of HTML views: 1
Total number of PDF views: 11 *
View data table for this chart

* Views captured on Cambridge Core between September 2016 - 24th January 2021. This data will be updated every 24 hours.

Hostname: page-component-76cb886bbf-m9qpn Total loading time: 0.476 Render date: 2021-01-24T23:29:50.718Z Query parameters: { "hasAccess": "0", "openAccess": "0", "isLogged": "0", "lang": "en" } Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": false, "newCiteModal": false }

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Detection and treatment of akathisia in advanced cancer patients during adjuvant analgesic therapy with tricyclic antidepressants: Case reports and review of the literature
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Detection and treatment of akathisia in advanced cancer patients during adjuvant analgesic therapy with tricyclic antidepressants: Case reports and review of the literature
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Detection and treatment of akathisia in advanced cancer patients during adjuvant analgesic therapy with tricyclic antidepressants: Case reports and review of the literature
Available formats
×
×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *