Is akathisia common with Trintellix (vortioxetine)?

Akathisia with Trintellix (Vortioxetine)

Based on available evidence, akathisia is not specifically documented as a common side effect with Trintellix (vortioxetine), though SSRIs as a class can cause akathisia and clinicians should remain vigilant for this adverse effect.

Evidence Limitations

• The provided evidence does not contain specific data on akathisia incidence rates with vortioxetine (Trintellix) 1
• Available research focuses primarily on antipsychotic-induced akathisia (20-30% with typical antipsychotics, lower with atypicals) and other medication classes 2
• SSRI-induced akathisia has been documented with fluoxetine, where symptoms were indistinguishable from neuroleptic-induced akathisia but generally milder 3

Clinical Recognition and Monitoring

Akathisia presents with both subjective and objective components that must be distinguished from other conditions:

• Subjective symptoms: Inner restlessness and urge to move 4
• Objective signs: Rocking while standing or sitting, lifting feet as if marching on the spot, crossing and uncrossing legs while sitting 4
• Critical distinction: Akathisia can be misinterpreted as psychotic agitation or anxiety, potentially leading to inappropriate medication increases 1

SSRI-Specific Considerations

If akathisia develops with Trintellix, clinicians must systematically assess for suicidality, as SSRI-induced akathisia is associated with increased suicidal ideation:

• The American Academy of Child and Adolescent Psychiatry recommends being especially alert to suicidality if SSRI treatment is associated with onset of akathisia 1
• Clinicians should systematically inquire about suicidal ideation before and after treatment initiation 1

Management Algorithm if Akathisia Occurs

First-line interventions:

• Reduce the vortioxetine dosage while remaining within therapeutic range 1
• Consider discontinuation if symptoms are severe 5

Second-line pharmacological treatment:

• Propranolol (10-30 mg two to three times daily) is the most consistently effective treatment for akathisia 1, 4
• Beta-blockers show the most consistent efficacy across studies 4, 6

Third-line options if beta-blockers fail:

• Benzodiazepines (such as clonazepam) can provide symptomatic relief and address the anxiety component 1
• This is particularly sensible if subjective distress persists 4

Fourth-line considerations:

• Amantadine or clonidine can be tried if other treatments are unsuccessful 4
• Anticholinergic agents are notably less effective for akathisia compared to other extrapyramidal side effects 1

Common Pitfalls to Avoid

• Do not increase the antidepressant dose if akathisia is mistaken for worsening anxiety or agitation 1
• Do not rely on anticholinergics as first-line treatment despite their common prescription, as they are less effective for akathisia 1
• Do not overlook the suicidality risk associated with SSRI-induced akathisia 1