Naloxone Rebound Akathisia: It Could Turn on You

by Russell Copelan MD: For Entire Post, Click Here…

ngd-In the opinion of many people I know with severe mental illness, akathisia is the single worst and most undermining side-effect they have from antipsychotic medications. It is also effectively and routinely ignored by the psychiatric establishment. It is terrible to hear that it can be a result of Naloxone…

The rise in opioid overdoses warrants a review of the symptoms of akathisia.

Overdose deaths involving opioids, including prescription opioids, heroin, and synthetic opioids (like fentanyl), have increased over six times since 1999 and have soared nearly 30% in 2020.

Before the coronavirus pandemic, the nation was struggling with escalating drug overdose deaths. Now, there are some who are convinced that the COVID-19 pandemic has led to further increases in opioid overdoses. Public services were disrupted. Some treatment programs had to restrict access, reduce staffing, and increase supply between limited provider visits. Many addicts are homeless and do not have Internet or telemedicine contact. Social distancing may have prevented some individuals from having anyone around to administer naloxone (Narcan, Evzio). Inadequate border restrictions have likely increased drug supply with higher potency.

With the rise in opioid use and death, a review of the many and sometimes paradoxical expressions of akathisia is warranted.

As I’ve written in several recent articles, akathisia comprises a family of distressing mental and irresistible motor symptoms fittingly called the dysexecutive function syndrome. Although patients often cannot locate the source of their suffering, it can feel unbearable and lead to suicide. Its associated mental subjective symptoms, which can include irritability, panic, and emotional unease, distinguish it from a dyskinesia. Its causes are legion and often unobvious.

Commonly associated with varying classes of medications, etiologies also include infectious, metabolic, and iatrogenic factors. And there is the potential for admixed categories or cross factor multipliers.

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