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What are Extrapyramidal Side Effects?

Tricia Christensen
Tricia Christensen
Tricia Christensen
Tricia Christensen

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.

Extrapyramidal side effects are generally linked with antipsychotic drugs.
Extrapyramidal side effects are generally linked with antipsychotic drugs.

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.

Extrapyramidal side effects are linked to certain types of medications that reduce dopamine levels.
Extrapyramidal side effects are linked to certain types of medications that reduce dopamine levels.

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.

Research suggests that people who take antipsychotics for depression and bipolar disorder experience extrapyramidal side effects.
Research suggests that people who take antipsychotics for depression and bipolar disorder experience extrapyramidal side effects.

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.

Akathisia creates a sense of inner restlessness that makes it difficult to engage in normal activities.
Akathisia creates a sense of inner restlessness that makes it difficult to engage in normal activities.

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.

Tricia Christensen
Tricia Christensen

Tricia has a Literature degree from Sonoma State University and has been a frequent TheHealthBoard contributor for many years. She is especially passionate about reading and writing, although her other interests include medicine, art, film, history, politics, ethics, and religion. Tricia lives in Northern California and is currently working on her first novel.

Tricia Christensen
Tricia Christensen

Tricia has a Literature degree from Sonoma State University and has been a frequent TheHealthBoard contributor for many years. She is especially passionate about reading and writing, although her other interests include medicine, art, film, history, politics, ethics, and religion. Tricia lives in Northern California and is currently working on her first novel.

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    • Extrapyramidal side effects are generally linked with antipsychotic drugs.
      By: Alex Bramwell
      Extrapyramidal side effects are generally linked with antipsychotic drugs.
    • Extrapyramidal side effects are linked to certain types of medications that reduce dopamine levels.
      By: krutoeva
      Extrapyramidal side effects are linked to certain types of medications that reduce dopamine levels.
    • Research suggests that people who take antipsychotics for depression and bipolar disorder experience extrapyramidal side effects.
      By: Antonioguillem
      Research suggests that people who take antipsychotics for depression and bipolar disorder experience extrapyramidal side effects.
    • Akathisia creates a sense of inner restlessness that makes it difficult to engage in normal activities.
      By: Monkey Business
      Akathisia creates a sense of inner restlessness that makes it difficult to engage in normal activities.
    • Extrapyramidal side effects may include tremors significant enough to interfere with everyday activities.
      By: michaeljung
      Extrapyramidal side effects may include tremors significant enough to interfere with everyday activities.
    • The types of extrapyramidal side effects that may occur in one individual are not easy to predict.
      By: Alliance
      The types of extrapyramidal side effects that may occur in one individual are not easy to predict.