What Is Akathisia?

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What Is Akathisia?

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; between 15% and 45% of people who take antipsychotic medications experience akathisia. However, it 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, the prevention of akathisia is key.

Types

There are several types of akathisia, depending on the onset and longevity of symptoms:

  • Acute akathisia: Begins shortly after taking antipsychotics and lasts less than six months
  • Chronic akathisia: Begins shortly after taking antipsychotics and lasts less than six months
  • Tardive akathisia: Begins after an extended period (one to three months) of antipsychotic use and may begin after antipsychotic discontinuation or dosage reduction
  • Withdrawal akathisia: Begins within six weeks after you switch or stop an antipsychotic drug

Symptoms

If you have akathisia, you may have restless movements of the arms and 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.

Common symptoms of akathisia include:

  • Crossing and uncrossing the legs
  • Fidgeting
  • Foot or finger tapping
  • Marching in place
  • Pacing
  • Rocking
  • Shifting weight from one leg to another

Other symptoms include:

  • Anxiety
  • Feelings of tension or panic
  • Irritability
  • Lack of patience

Diagnosis

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 the drugs are meant to help manage.

If you suspect akathisia, it’s important to see your doctor to get an official diagnosis. Do not stop taking medication on your own.

To diagnose akathisia, your doctor will likely perform a physical exam, which includes observing you sitting and standing for several minutes to watch for psychomotor agitation. Your doctor may also fill out the Barnes Akathisia-Rating Scale to assess the severity of your symptoms. This tool can also be used to track your progress during treatment.

In addition, your doctor will ask about your current medications and rule out any other health conditions that can cause similar symptoms, including:

  • ADHD
  • Agitated depression
  • Anxiety
  • Insomnia
  • Mania
  • Parkinson's disease
  • Psychosis
  • Restless legs syndrome
  • Tardive dystonia
  • Tardive dyskinesia (TD)

Causes

While akathisia is a common side effect of certain medications, researchers have yet to understand why or how it causes symptoms of restlessness. Some believe it is caused by a chemical imbalance triggered by the medication. It overstimulates areas of the brain, potentially resulting in the compulsion to move. 

Not everyone who takes antipsychotic drugs will experience akathisia, however, it is often a side effect of older, first-generation antipsychotics used to treat bipolar disorder and schizophrenia, including:

  • Compro (prochlorperazine)
  • Fluanxol (droperidol)
  • Haldol (loxapine)
  • Mellaril (thioridazine)
  • Moban (molindone)
  • Navane (thiothixene)
  • Orap (pimozide)
  • Prolixin (fluphenazine)
  • Stelazine (trifluoperazine)
  • Thorazine (chlorpromazine)

Akathisia is also common with haloperidol and the newer, second-generation agents Abilify (aripiprazole) and Latuda (lurasidone). Invega (paliperidone) and Geodon (ziprasidone) are on the very low end of medications thought to cause akathisia.

It's important to note that all antipsychotic drugs carry with them the risk of causing akathisia.

Other medications known to cause akathisia include:

  • Anti-nausea drugs
  • Calcium channel blockers
  • Drugs that treat vertigo
  • Sedatives before surgery
  • Selective serotonin reuptake inhibitors (SSRIs)

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

If you've been diagnosed with akathisia, your doctor may decrease your dosage or discontinue the medication causing your symptoms. However, modifying your mediation may also cause symptoms to worsen, or cause withdrawal akathisia.

A number of medications have been used to treat the symptoms of akathisia including:

  • Beta-blockers, such as Hemangeol and Inderal (propranolol)
  • Anticholinergic medications, such as Cogentin (benztropine) and Akineton (biperiden)
  • 5-HT2A antagonists, such as Tolvon (mianserin), Remeron (mirtazapine), Desyrel (trazodone), and Periactin (cyproheptadine)
  • Vitamin B6 in high doses (600mg to 1,200mg daily)

Coping

An important part of coping with akathisia is managing your medication. Do your best to keep a detailed record of the medications you are taking, including the dosage and when you started taking them. If you experience any symptoms of akathisia, share the record with your healthcare provider.

While your prescribing doctor should have your medication history, they may not have it in a compact form.

If you're feeling alone or frustrated about your symptoms, it can also help to confide in a trusted friend or family member. Consider joining an online support group of others who understand what you're going through.

If you or a loved one are struggling with a mental health issue, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

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Article Sources
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