What is it about?

This report presents a case of drug-induced severe tardive akathisia that developed after concurrent use of an SSRI and an antipsychotic in a woman with severe major depression. Trial and combination of multiple medications is common practice in non-responding depressive patients. With the increase in prevalence of treatment-resistant depression, adverse effects of medication such as tardive akathisia are becoming more common. Tardive akathisia persists even after the withdrawal of the causative agent and is very challenging to treat. The patient did not respond to any standard medications recommended in drug-induced akathisia. As a result, the patient became suicidal and extremely distressed with no available treatment options remaining. Guidelines on management of drug-induced tardive akathisia are non-existent. This reflects the importance of this study which reveals complete remission of all her symptoms after Electro-Convulsive Therapy (ECT). This report provides evidence of an established treatment intervention used in a new situation, achieving remission of both treatment-resistant depression and drug-induced tardive akathisia.

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Why is it important?

This is the first report in medical literature revealing complete remission of both treatment-resistant depression and tardive akathisia following electroconvuslive therapy sessions. Akathisia is increasing in incidence due to an increase in the prescription and combination of psychiatric medications to tackle treatment-resistant depression. This condition is often misdiagnosed and underestimated in clinical practice while it causes significant distress and suffering to patients. We present a well established treatment intervention (ECT) used in a novel situation successfully remitting all symptoms of both akathisia and depression.

Perspectives

This study represents a well established treatment method that brought remission of a detrimental condition called tardive akathisia. This condition is often underestimated however the amount of suffering it causes to patients suffering from it is enormous. Hence, a very large percentage of patients end up suicidal and have to be hospitalized yet cannot be helped with current treatment options. This study opens the horizons for further studies to be carried on the effects of ECT in the treatment of both depression and akathisia plus other movement disorders.

thanos emmanuel
Barts and the London School of Medicine, Queen Mary University of London

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This page is a summary of: Remission of treatment-resistant depression with tardive akathisia with electroconvulsive therapy, BMJ Case Reports, September 2019, BMJ, DOI: 10.1136/bcr-2019-229714.
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