Vitamin B6 Effective in Reducing Antipsychotic Induced Akathisia

A recent RCT showed that vitamin B6 is as effective as propranolol for the treatment of akathisia

Bernalyn Ruiz
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A randomized controlled trial conducted at the Kurdistan University of Medical Sciences compared the efficacy of vitamin B6 to propranolol for the treatment of antipsychotic-induced akathisia (AIA). The study demonstrated that there was no significant difference between vitamin B6 and propranolol in reducing akathisia symptoms, suggesting that vitamin B6 may be beneficial for improving antipsychotic-induced akathisia.

Akathisia is characterized by “restless movements and typical subjective complaints of restlessness referable to the legs, inner tension, and discomfort” and “is reported to be the most common reason cited by patients for discontinuing their medications.” First line treatment of akathisia typically consists of propranolol and can also include the modification of the antipsychotic dose.

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The authors of this study highlight that the first line treatment (propranolol) is not effective in up to 70% of persons experiencing AIA and is not well tolerated in patients with bronchial asthma, diabetes mellitus, or hypotension. Second line treatments for AIA often include anticholinergics, benzodiazepines, amantadine, clonidine, and dopamine agonists. The authors of this study explored the efficacy of vitamin B6 for the treatment of acute akathisia. They draw on prior evidence has demonstrated that B6 can be effective in the treatment of movement disorders caused by psychotropic medication.

This study aimed to compare the efficacy of vitamin B6 and propranolol for antipsychotic-induced akathisia (AIA). Fifty-one individuals who had been diagnosed with antipsychotic-induced akathisia were recruited for the study; 17 patients were placed on 300 mg/12h or vitamin B6, 17 were placed on 600 mg/12 h of propranolol, and the remaining 17 participants were placed on 20mg/12 h of propranolol. The severity of akathisia symptoms was measured using the Barnes Akathisia Rating Scale. The items assess observable, restless movements, subjective awareness of restlessness, distress associated with akathisia, and global severity.

Patients included in the study were between 18-50 years of age, on antipsychotics, and had at least a mild rating of akathisia. A total of fifty-one patients were included, 17 on propranolol, 17 on vitamin B6 300 mg/12h, and 17 on 600 mg/12 h of vitamin B6. There were no significant differences on BARS scores at baseline, diagnosis (schizophrenia, schizoaffective, psychosis, bipolar disorder, or other disorder) at baseline, or adherence to medication throughout the study between the three groups. Data also showed that there was no significant difference in BARS scores between the three groups, suggesting that B6 was as effective as propranolol in mitigating symptoms of akathisia.

This is the first study which has shown support for vitamin B6 in reducing symptoms of akathisia. This is an important finding as typically the treatment of akathisia is done through other psychotropics including benzodiazepines, beta-adrenergic blockers, and anticholinergics. Moreover, this intervention has lower adverse side effects that the typical first- and second-line interventions for AIA.

 

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Hassanzadeh, K., Shams-Alizadeh, N., Bakhshayesh, H., Rezaei, F., Ghaderi, E., & Shams-Alizadeh, N. (2018). Effect of Vitamin B6 versus Propranolol on Antipsychotic-Induced Akathisia: A pilot comparative double-blind study (Winter Special Issue 2018). Iranian Journal of Pharmaceutical Research. (Link)

7 COMMENTS

  1. Akathisia is an extremely serious condition involving toxic psychosis, not just a movement disorder.

    Propranolol can not really treat Akathisia, but the biology says it’s possible B6 can help because it is a co-factor of glutamate decaboxylase required for the synthesis of gamma Aminobutyric acid.

    http://www.worthington-biochem.com/GLDP/

    The best way to deal with Akathisia is to correctly tapper off the neurotoxins, take magnesium which serves in tandem with B6 in correctly controlling the transmission of glutamate via the NMDA receptor. Also to avoid food stuffs that inhibit glutamate decaboxylase. The other very important thing that is necessary, is avoiding all the common food stuffs and herbs/spices that inhibit the metabolising enzymes: Cytochrome P450, some of them can be found here:

    https://www.ebmconsult.com/content/pages/medications-herbs-cytochrome-p450-cyp-enzyme-inhibitors

    Alpinia galanga – ginga inhibits CYP 2D6

    Cinnamomum burmannii – cinnamon inhibits CYP 2D6

    Piper nigrum – black pepper – inhibits CYP 2D6

    Allium sativum – garlic – inhibits CYP 3A4

    Naringenin compounds – found in grapfruit inhibits CYP 3A4

    Others here:

    http://www.todaysdietitian.com/newarchives/121610p26.shtml

    Do a search for more.

    Also, idealistically, a person should have a Cytochrome P450 test. People in the US should all look into this, see if it is covered by your insurance. This is the type of thing, should point out I have nothing to do with that company, just posting it, so as to describe the relevance:

    https://www.youtube.com/watch?v=JnNI6JEFf38

  2. I had never heard of the Barnes Scale. It seems to focus on an inability to keep still? I suffered akithisia so frequently as a young person without my doctors understanding, that I trained myself to override it and hold very still. Because if I didn’t, I’d get even more medications. I would physically feel like I was in a maelstrom though.

    • Thanks for letting people know about your childhood experience. There is something called mild akathisia that is sometimes experienced as remaining motionless. (Not saying yours was mild, by the way.) I had some kind of hellish neurotoxicity that meant the most miserable two years imaginable, or worse, and towards the end spent a great deal of time sitting motionless. My mind would be running at full tilt but I couldn’t conjure up a will to move. Heartbeat and breathing, probably some blinking, were the extent of my physical activity, and only because they have wills of their own.