From the Guidelines
Benadryl can be used to treat akathisia, but it is not the preferred first-line treatment, and its use should be considered in the context of the patient's overall treatment plan, as recommended by the American Psychiatric Association 1. When considering the treatment of akathisia, it is essential to weigh the potential benefits and risks of each option, prioritizing those that minimize morbidity, mortality, and impact on quality of life. According to the American Psychiatric Association's practice guideline for the treatment of patients with schizophrenia 1, the management of akathisia associated with antipsychotic therapy may include lowering the dosage of the antipsychotic medication, switching to another antipsychotic medication, adding a benzodiazepine medication, or adding a beta-adrenergic blocking agent. Some key points to consider when treating akathisia include:
- The potential side effects of Benadryl, such as drowsiness, dry mouth, blurred vision, and confusion, especially in elderly patients.
- The importance of addressing the underlying cause of the akathisia, rather than just treating the symptoms.
- The need for a comprehensive and person-centered treatment plan that includes evidence-based nonpharmacological and pharmacological treatments, as recommended by the American Psychiatric Association 1. In terms of specific treatment options, the American Psychiatric Association suggests 1 that patients with akathisia associated with antipsychotic therapy may be treated with a benzodiazepine medication or a beta-adrenergic blocking agent, in addition to considering a change in antipsychotic medication or dosage. Given the potential risks and benefits of each treatment option, the use of Benadryl for akathisia should be carefully considered and monitored, with a focus on minimizing morbidity, mortality, and impact on quality of life 1.
From the Research
Treatment Options for Akathisia
- The available evidence suggests that antipsychotic-induced akathisia can be managed by reducing the medication dose or switching to a second-generation antipsychotic that is less prone to inducing akathisia 2.
- Pharmacological agents such as beta-blockers, anticholinergics, clonidine, and benzodiazepines have been examined as treatment options for antipsychotic-induced akathisia 3, 4.
- Low-dose mirtazapine has demonstrated compelling evidence for therapeutic efficacy in the treatment of antipsychotic-induced akathisia 5.
Use of Benadryl for Akathisia
- There is no mention of Benadryl (diphenhydramine) as a treatment option for akathisia in the provided studies.
- The studies suggest the use of other agents such as beta-blockers, anticholinergics, and benzodiazepines for the management of akathisia, but do not provide evidence for the use of Benadryl 2, 3, 5, 4, 6.
Alternative Treatment Approaches
- The treatment of antipsychotic-induced akathisia should be personalized, with consideration of antipsychotic dose reduction, cessation of antipsychotic polypharmacy, and switching to an antipsychotic with a perceived lower liability for akathisia, before the use of adjuvant medications 6.
- The choice of adjuvant medications should favor the more established treatments, with careful consideration of contraindications and side effects 6.