Akathisia Causes and Treatment

What to Do If Your Bipolar Medication Is Causing Restlessness

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Akathisia, also spelled acathisia, is a neuropsychiatric syndrome or movement disorder characterized by inner restlessness and the inability to sit or stand still for a reasonable period of time. Akathisia may appear as a side effect of the long-term use of antipsychotic medications, Lithium, and some other neuroleptic drugs. It is one of the most common side effects of antipsychotic medications, but may be hard to describe by patients and thus hard to diagnose by doctors.

When akathisia is induced by drugs, it is known as antipsychotic-induced acute akathisia (AIAA). Because it's known to happen as a result of treating a mental disorder, prevention of akathisia is key, while getting off of your medication is not advisable or a viable option to treat akathisia. Here we share ways you can overcome akathisia without jeopardizing your health and well-being while taking psychiatric drugs.

The Prevalence of Akathisia

Between 20 and 45 percent of people who take antipsychotic medications experience akathisia. The Barnes Akathisia-Rating Scale is used to diagnose the condition. If you suffer from akathisia, you may have restless movements of the arms and legs such as tapping, marching in place, rocking, crossing and uncrossing the legs. This is sometimes referred to as psychomotor agitation

Your body may feel anxious at the thought of sitting down. Your body will always want to be on the move, almost to the point of fidgeting whenever stillness sets in. There are four types of movement disorders associated with antipsychotic drugs. Sometimes akathisia can be grouped with these other movement disorders, or it may be isolated to only one:

  • Tardive dyskinesia (TD)
  • Parkinsonism
  • Akathisia, which we cover here
  • Tardive dystonia

Causes of Antipsychotic-Induced Akathisia 

Akathisia is generally underdiagnosed or misdiagnosed. The prevalence of missed diagnosis is a dangerous problem as it can lead to negative outcomes such as missed medication dosages, which may exacerbate the psychiatric symptoms they are meant to help manage.

Because this condition is generally caused by prescription drugs, it's important to be aware of the studies that explain specific drugs associated with a heightened risk of akathisia. Haloperidol, paliperidone, and ziprasidone have all been seen to increase the risk of akathisia for patients taking these drugs. While these have been singled out, it's important to note that all antipsychotic drugs carry with them the risk of causing akathisia.

Unfortunately, just as starting antipsychotic medication may cause akathisia, it is also observed in people who are being gradually taken off their antipsychotic medication or who may be advised to gradually decrease their dosages. In these instances, intense dysphoria is often observed as well.

Treatment for Akathisia

The goal of treatment for akathisia is generally to promote calmness, without over-sedating. A study in the journal Drug Safety suggests that additional drugs may be given to people with bipolar disorder to treat akathisia.

Specifically, lipophilic beta-blockers like propranolol have been found to be consistently effective for the treatment of acute akathisia. Adding benzodiazepines or amantadine or clonidine has also been tried. Other drugs that have been used to treat akathisia include piracetam, ritanserin, valproic acid, and tricyclic antidepressants. More recently, mirtazapine has been found to work for 20-25% of people, some of who have experienced complete remission of their akathisia symptoms. 

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Article Sources

  • Praharaj SK, Kongasseri S, Behere RV, Sharma PS. Mirtazapine for Antipsychotic-Induced Acute Akathisia: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials. Therapeutic Advances in Psychopharmacology. 2015 Oct;5(5):307-13.

  • Miller CH, Fleischhacker WW. Managing Antipsychotic-Induced Acute and Chronic Akathisia. Drug Safety 2000 Jan;22(1):73-81.