Akathisia and Borderline Personality Disorder

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Akathisia is a common side effect of antipsychotic and antidepressant medications used to treat borderline personality disorder (BPD). Its main symptoms are extreme restlessness and discomfort. If you have akathisia, you may feel compelled to move, particularly your legs. It will cause you to constantly want to fidget or shift from one leg to the other. While it may sound harmless, akathisia can be very irritating and can cause people with BPD to discontinue their medicine. It's important to recognize the symptoms of this side effect and talk to your doctor about them to get the best medicine for your situation. 


Scientific understanding of akathisia is currently very limited. While it is recognized as a common side effect of certain medications, doctors don't understand why or how it causes symptoms of restlessness. Some researchers suggest that it is caused by a chemical imbalance caused by the medication. It overstimulates areas of the brain, potentially resulting in the compulsion to move. 

How Is Akathisia Recognized?

Recognizing akathisia can be difficult, as it sometimes can appear to be a heightened version of your BPD symptoms. In some people, it makes them more anxious and nervous. In others, it is solely evidenced by the constant movement of the hands, feet or arms. In some rare cases, the akathisia has caused symptoms like rage, fear, nausea and psychotic symptoms. 

The symptoms of akathisia often mimic or overlap with those of other illnesses, such as general anxiety disorder, depression or mania. In some cases, the sensation of this side effect is so odd that patients have difficulty explaining how they're feeling, limiting the possibility for effective treatment. 

Because of how easily akathisia can be confused with other illnesses or symptoms, a consultation with a clinician experienced in this side effect is usually recommended.

They will use a tool such as the Barnes Akathisia Rating Scale to determine its presence and severity. 

How Is Akathisia Treated?

Once akathisia has been diagnosed, it is typically treated by discontinuing the use of whatever antidepressant or antipsychotic medication you are on. Depending on your situation, your healthcare provider may opt to simply lessen your dose rather than discontinue its use completely or she may prescribe a new medication. 

In some cases, your doctor may also prescribe a beta-blocker to treat the akathisia symptoms. Beta-blockers prevent certain receptors that encourage increased cardiac activity from being activated. They are often used to treat high blood pressure or heart issues. Beta-blockers have been found to decrease or eliminate symptoms of akathisia when taken daily, so they are an effective treatment option for some people. However, beta-blockers have their own potential side effects, so talk to your doctor about your options and what sort of signs to look out for. 

Bottom Line

While akathisia is a common side effect of medication used to treat BPD, it is treatable and manageable. If you experience akathisia and are tempted to stop taking your medicine because of it, talk to your doctor about what you are feeling and your concerns. He will help you identify a solution that will make you more comfortable while maintaining your path to recovery. 

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  • Forcen, F. "Akathisia: Is restlessness a primary condition or an adverse drug effect?" Current Psychiatry. 2015, 14-18.