Akathisia, which characterized by subjective
restlessness and objective hyperactivity, is induced mostly by
antipsychotics and
antidepressants. Chronic
akathisia is defined as persistence of symptoms for more than 3 months. The pathophysiology of chronic
akathisia remains unclear. This report describes a depressed patient, a 66-year-old woman with a diagnosis of
major depressive disorder, with chronic
akathisia. Her regional cerebral blood flow (rCBF) was measured using single photon emission computed tomography (SPECT) before and after the treatment with electroconvulsive therapy (ECT). She had experienced
akathisia-like symptoms three times prior because of
risperidone,
escitalopram, and
clomipramine administration, accompanied by major depression. After
levomepromazine was added to
quetiapine to treat
insomnia, she developed
akathisia symptoms such as a sense of
restlessness and inability to sit in one place for a few minutes. These
antipsychotics were withdrawn.
Propranolol was administered, leading to no apparent improvement for 8 months. After she was diagnosed as having
major depressive disorder and chronic
akathisia, she received 10 sessions of bilateral ECT. Her depressive symptoms improved greatly.
Akathisia disappeared completely after ECT. SPECT revealed that rCBF was decreased in the middle frontal gyrus and parietal lobe, that it was increased in the thalamus, fusiform gyrus, and cerebellum before ECT, and that these abnormalities in rCBF were approaching normal levels after ECT. Findings presented in this report suggest ECT as a beneficial treatment for chronic
akathisia. Altered rCBF in the middle frontal gyrus, parietal lobe, thalamus, fusiform gyrus, and cerebellum, and especially decreased rCBF in the parietal lobe, may be related to the pathophysiology of chronic
akathisia.