Agitation, as with many English words, has multiple definitions. Here are a few:
1. moving back and forth with an irregular, rapid, or violent action
2. a feeling of being restless
3. a state of excessive tension and irritability
4. a state of anxiety, emotional disturbance, worry, upset, or nervous excitement
[From Latin agitare, put into motion]
Agitation is a side effect of various psychotropic drugs, such as psychostimulants given to children for so-called ADHD; newer antidepressants such as SSRIs; antipsychotics often called major tranquilizers; anti-anxiety drugs often called minor tranquilizers.
So, pretty much all psychiatric drugs, often prescribed to reduce agitation, have a side effect of agitation. Counter-productive, wouldn’t you say?
The psychiatric billing bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM), specifies some diagnoses related to agitation:
— Restless legs syndrome
— 54 individual diagnoses using the word “anxiety”
— High expressed emotion level within family
— Adjustment disorder, With mixed disturbance of emotions and conduct
Pretty much anybody, then, can be diagnosed with some form of agitation or anxiety and prescribed one or more psychiatric drugs which have the potential to exacerbate the agitation.
The Latest Agitation Drug
On April 6, 2022 the US Food and Drug Administration (FDA) approved BioXcel Therapeutics dexmedetomidine (Igalmi™) sublingual film for the acute treatment of agitation associated with schizophrenia or bipolar I or II disorder in adults.
Dexmedetomidine is a sedative whose safety and effectiveness cannot be established beyond 24 hours from the first dose, usually used to anesthetize a patient or animal before surgery. It inhibits the release of norepinephrine in the brain, stopping propagation of pain signals. They don’t really know how it “works” for agitation, other than the obvious fact that it knocks you out. It’s mostly eliminated from the body within hours. It’s metabolized in the liver by Cytochrome P450 (CYP450) enzymes, so the side effects can be exacerbated by abnormal CYP450 metabolism which can lead to a toxic level causing acute agitation.
The most common side effects (incidence ?5% and at least twice the rate of placebo) were sleepiness, burning or prickling sensations, oral numbness, dizziness, dry mouth, and low blood pressure.
Since it is self-administered by placing the film under the tongue, it’s used by an individual to knock themselves out when they are having an anxiety attack.
Psychiatrists promoting this “treatment” are ecstatic about it, since the patients can knock themselves out whenever they feel the need.
If you feel the need, please contact your local, state and federal representatives and let them know what you think about this.
