Neuroleptic drugs suicide

Akathisia was first described in association with neuroleptic drugs. The inner agitation associated with akathisia can become extremely uncomfortable, causing the individual to feel tortured from within (see vivid descriptions in Van Putten, 1974, 1975a b Breggin, 1997a), leading to extreme irritability and suicide or violence. 

Akathisia is a variant of the restless legs syndrome associated with anxiety and/or dysphoria (SEDA-19, 44) (SEDA-20, 36) (209-211). It can be confused with an exacerbation of the disorder being treated. Suicidal tendencies can occur in psychotic patients who developed neuroleptic-induced akathisia (212). On the other hand, recent evidence suggests that depressive symptoms may not be induced or worsened, and may even be reduced, by prescribing atypical neuroleptic drugs (213-215). Subjects show various degrees of restlessness and an inability to sit or stand still in severe cases, the presentation can merge with behavioral disorders. 

Suicide, suicidality, and suicidal ideation are very serious problems in patients with schizophrenia. Based on general observations that 1-2% of patients with schizophrenia complete suicide within 1 year after initial attempts, the authors of a retrospective study of 295 neuroleptic drug-resistant patients with schizophrenia who had taken clozapine monotherapy for at least 6 months would have expected as many as 10 or 11 successful suicides or suicide attempts, but none was observed (107). 

In addition to the somatic side-effects of neuroleptics, there are a number of important psychiatric side-effects, such as demotivation or indifference (a direct effect of most drugs, actually part of the definition of the neuroleptic effect). This may mimic the negative features of the illness and may lead to prescriptions of an antidepressant when a reduction in dose or change of antipsychotic may be more appropriate. A second key problem is anxious activation or akathisia. This dose-dependent dysphoric state may lead to an apparent worsening in the clinical picture and accordingly an increase in antipsychotic dose rather than decrease and may be so intolerable as to lead on to suicide. 

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