The risks of long-term neuroleptic treatment of schizophrenia: especially depression and akinesia.

Most extrapyramidal side effects of neuroleptics are easily recognized and cause little problem in diagnosis and treatment. The exceptions are those which mimic psychopathology: akathesia and akinesia. Akathesia resembles anxiety. Akinesia is similar to depression, residual schizophrenia, and demoralization. Differential diagnosis may require interruption of the neuroleptic. Whether neuroleptics can cause depression not associated with akinesia has never been established. The first obligation of the clinician is to be sure that the depressive symptoms are not concomitants of akinesia, before treating with antidepressants which may not be the appropriate treatment. There is no convincing evidence that one neuroleptic drug is more likely to cause akinesia than another, although this had not been studied extensively using a broad definition of akinesia.