What is the risk of akathesia and suicide and other serious symptoms of on invega sustana ? Are there any reports ? Studies ?

The short version: the evidence from these records shows that akathisia is a real and reported side effect of Invega Sustenna (paliperidone palmitate), but does not answer your question about suicide risk because no study here was designed to measure it in the population you are likely asking about.

One clinical trial reported akathisia in 4.4% of patients receiving the 3-month formulation, compared to 0.7% on placebo [1]. A larger comparative study found it in 13.1% of patients on the monthly injection [2]. That same study tracked suicide events: zero in the paliperidone group, three in the group receiving a different long-acting injectable [2]. But look closely at what that means. The trial was designed to show the drug works, not to catch rare or serious harms. A single case report in these records describes using the Barnes Akathisia Rating Scale to monitor a patient, confirming the symptom is clinically recognized [4]. The larger network meta-analysis, pooling 56 trials across many antipsychotics, found no significant differences in death or suicide attempts compared to placebo for any drug [3]. That sounds reassuring only if you trust that the trials were long enough and big enough to see the signal. A one-year observational study had a 34% dropout rate, and adverse effects were one listed reason [5].

The honest answer is that the published studies you can find are too small and too short to rule out serious harms like suicide. The mechanism is plausible: akathisia is a known extrapyramidal effect of these drugs, and severe akathisia is strongly linked to suicidality in the psychiatric literature (outside these records). Post-marketing reports to regulators, which are not included here, would be the place to look for the signal these trials cannot see.

My call: akathisia is a documented and common side effect; suicide risk is a known concern from the drug class that these studies were not built to measure. Confidence: moderate on akathisia, low on suicide from this evidence alone.