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What are Extrapyramidal Side Effects?

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  • Written By: Tricia Ellis-Christensen
  • Edited By: O. Wallace
  • Last Modified Date: 16 November 2016
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Extrapyramidal side effects are side effects linked to certain types of medications that suppress or reduce dopamine levels. These side effects are typically associated with antipsychotic drugs, which in part work because they lower dopamine levels. It was previously thought that the problem of extrapyramidal side effects was most felt in what were the older or typical antipsychotic medications and that a number of newer atypical drugs reduced the risk of these symptoms developing. Increasing evidence suggests atypical antipsychotics have plenty of extrapyramidal side effects and these are experienced regularly among some people who must use these medicines, including people with conditions like schizophrenia, bipolar disorder and an increasing number of people prescribed atypical antipsychotics for resistant depression.

The types of extrapyramidal side effects that might occur in one individual aren’t easy to predict, and many people can use antipsychotics for long periods of time with no symptoms. Over time, the risk of side effects increases, but in a contradictory way, some people develop symptoms of dopamine suppression very early in treatment. In the most severe scenarios, a person develops a condition like an involuntary movement disorder that does not discontinue with drug discontinuation. Most would find that either using additional drugs to treat the side effect, or switching to another medication would cause symptoms to cease.

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Some examples of extrapyramidal side effects include disorders of movement like dystonia, which results in painful or incontrollable muscle contractions that can often be so severe they distort posture. Bradykinesia is another side effect, which slows movement, or people may suffer bradyphrenia resulting in less fluid ability to think and possibly reduced cognition.

Other conditions that develop are things like notably slurred speech or tremors, which can affect different parts of the body. In particular, conditions like tremors or involuntary muscle movements may not always resolve with discontinuation of a medicine. An additional symptom that can exacerbate any mental disorder is called akathisia. It creates a sense of profound inner restlessness that makes it difficult to engage in any normal activities, and that may be tremendously challenging to endure. People recovering from mental illness usually handle this symptom poorly because it feels like a continuation of mental illness.

With the new atypical antipsychotics like Abilify®, Geodon® and others, it was hoped that extrapyramidal side effects would be fewer, and sometimes they are. On the other hand, a medication like Abilify® has been linked to fairly high incidence of conditions like akathisia, often developing early in treatment. What these side effects express about certain drug treatments for mental disorder is that no perfect or ideal treatment has yet been reached.

Those who seek drug therapy are to be lauded for getting help for their condition and because they risk the possibly difficult and serious side effects that may result. The risks of extrapyramidal side effects don’t suggest people are better off without drug therapy. They do indicate that people with certain illnesses would be better off with more effective, safer drugs.

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