Which is the first-line approach for treating acute dystonia caused by antipsychotics?

• A. Beta-blockers
• B. Methylphenidate
• C. SSRI
• D. Anticholinergic drugs

Answer: (D)

Acute dystonia from antipsychotics stems from an imbalance in the basal ganglia where dopamine blockade increases acetylcholine activity, leading to sudden, painful muscle contractions. The best first-line treatment is an anticholinergic medication such as benztropine or diphenhydramine. These drugs quickly counteract the excess acetylcholine, often providing rapid relief—especially when given by injection for urgent symptoms. This direct approach targets the underlying neurotransmitter mismatch that causes dystonia, making it more effective than alternatives like beta-blockers (which are used for akathisia), stimulants, or SSRIs, which do not address the cholinergic-dopaminergic imbalance. If needed, administer these anticholinergics intramuscularly or intravenously for faster control, with oral forms available for milder cases.