Imagine trying to watch a movie, read a book, or even just sit with a friend for a chat. But instead of relaxing, there’s this… this thing inside you, a buzzing, antsy energy that just won’t let you be still. Your legs feel like they have a mind of their own, needing to tap, to cross and uncross, to get up and pace. That, in a nutshell, can be what Akathisia feels like for many. It’s more than just fidgeting; it’s a deeply uncomfortable, almost agonizing, inner restlessness.
So, What Exactly is Akathisia?
Alright, let’s break this down a bit. Akathisia is what we call a neuropsychiatric syndrome. Fancy words, I know. Basically, it’s a movement disorder where you feel an intense, almost unbearable need to move. The name actually comes from a Greek word, “akathemi,” which translates to “inability to sit.” And that really captures it.
It’s often linked to certain medications, especially antipsychotic medications (sometimes called neuroleptics), but a few health conditions, like Parkinson’s disease, can also be connected to it. This isn’t just about feeling a bit antsy; it’s a genuine compulsion, usually making your legs want to do something, anything, repetitively. It can be incredibly distressing.
We sometimes categorize Akathisia based on when it starts and how long it sticks around:
- Acute Akathisia: This pops up pretty quickly after starting a new medication (often an antipsychotic) or when a dose is increased. It usually hangs around for less than six months.
- Chronic Akathisia: If those restless feelings and movements last longer than six months, we’d call it chronic. And believe me, this can go on for months, sometimes even years.
- Tardive Akathisia: This one is a bit of a latecomer. It might show up more than three months after a medication change. It often walks hand-in-hand with something called tardive dyskinesia, another movement issue.
- Withdrawal Akathisia: Sometimes, when a medication dose is lowered or stopped altogether, this restlessness can flare up.
Akathisia vs. Anxiety: What’s the Difference?
This is a really common question I get in the clinic. “Doc, is this just bad anxiety?” And it’s a fair question because there’s overlap. Both can make you feel restless. But Akathisia is primarily a movement disorder. The core of it is that physical urge to move, not necessarily fear or worry-based thoughts like we see in typical anxiety. Now, that being said, having this uncontrollable need to move? Yeah, that often causes a lot of anxiety and distress. It’s easy to see why it sometimes gets misdiagnosed as just persistent anxiety.
How Common Is This Restlessness?
Akathisia is actually the most frequent movement issue we see linked to psychotropic medications – those are drugs that affect your mind and mood. It’s surprisingly common. For instance, studies suggest about 24% of folks with schizophrenia who are on medication experience chronic Akathisia. Some research has even shown rates as high as 39% for people taking clozapine and 45% for those on older, first-generation antipsychotics. So, you’re definitely not alone if this sounds familiar.
What Does Akathisia Look and Feel Like?
If you’re starting a new antipsychotic medication or your doctor has upped the dose, that’s when you might start noticing symptoms of Akathisia.
The main thing is that feeling of being incredibly restless inside, almost like you’re buzzing or jittery. It creates this powerful urge to move, especially your legs. You might find yourself:
- Constantly crossing and uncrossing your legs.
- Swinging your legs when you’re sitting down.
- Shifting your weight from one foot to the other when standing.
- Rocking back and forth in your chair.
- Pacing the room or marching in place.
To others, it might just look like you can’t stop fidgeting. But inside, it’s often a very different story. People describe it as an inability to relax, a mounting tension if they have to stay still, like waiting in line. This inner turmoil can lead to real anxiety and distress. Sadly, when Akathisia is chronic and severe, it has been linked to a higher risk of self-harm or suicidal thoughts. This is serious stuff.
If you’re having thoughts of harming yourself, please, please reach out for help immediately. You can call emergency services or a crisis lifeline. There are people who want to support you.
What’s Behind Akathisia?
We don’t have all the answers, to be honest. Scientists think Akathisia might happen when certain medications block dopamine receptors in your brain. Dopamine is a chemical messenger – a neurotransmitter – that’s super important for many things, including how we move. When these receptors are blocked, it can throw off the signals and lead to these unwanted, involuntary movements.
Several types of medications are associated with Akathisia:
Antipsychotic Medications
This is the big one. We often call it antipsychotic-induced Akathisia. These meds come in two main types:
- First-generation antipsychotics (FGAs), also called “typical” antipsychotics.
- Second-generation antipsychotics (SGAs), or “atypical” antipsychotics.
Akathisia tends to be more common with FGAs, especially at higher doses or with more potent drugs, compared to SGAs.
Doctors prescribe these for a whole range of conditions, like:
- Schizophrenia
- Bipolar disorder
- Severe depression
- Behavioral issues in dementia
- Anxiety disorders
- OCD, PTSD, and even insomnia.
Some examples of FGAs linked to Akathisia include haloperidol (Haldol®), chlorpromazine (Thorazine®), and fluphenazine (Prolixin®).
Among SGAs, drugs like paliperidone (Invega®) and ziprasidone (Geodon®) might carry a higher risk.
Antidepressants
Though less common than with antipsychotics, some antidepressants can also trigger Akathisia:
- Selective serotonin reuptake inhibitors (SSRIs): These are very common, like fluoxetine (Prozac®) and paroxetine (Paxil®).
- Monoamine oxidase inhibitors (MAOIs): Older drugs, less used now due to side effects, such as phenelzine (Nardil®).
- Tricyclic antidepressants (TCAs): Often used if other antidepressants haven’t worked, like amitriptyline (Elavil®).
Antidepressants are used for depression, anxiety, bipolar disorder, chronic pain, and more. It’s estimated that 10% to 18% of people with bipolar I disorder taking antidepressants might develop Akathisia.
Other Medications
A few other culprits can include:
- Anti-nausea meds like metoclopramide.
- Some blood pressure drugs, such as reserpine.
- Calcium channel blockers like diltiazem.
- Sedatives.
- Medicines for vertigo.
- Even some antibiotics, like azithromycin, and anti-anxiety meds like buspirone.
And it’s worth mentioning that illicit drugs like amphetamines and cocaine can also cause Akathisia.
Health Conditions
Beyond medications, certain health issues can be associated with Akathisia:
- Parkinson’s disease
- Encephalitis (inflammation of the brain)
- Traumatic brain injury (TBI)
How Do We Figure Out if It’s Akathisia?
Diagnosing Akathisia is mostly about what we see and what you tell us. There isn’t a specific blood test or brain scan for it. One tool we often use is the Barnes Akathisia-Rating Scale (BARS), which helps us assess the movements and your experience.
If you come to me worried about this, I’ll ask about your symptoms, your medical history, and especially the medications you’re taking. I’ll also watch how you move. It’s not always straightforward, though. Akathisia can look like other things – psychosis, mania, ADHD, or even just severe agitation from depression – so it sometimes gets missed or misdiagnosed. That’s why talking openly about exactly how you feel is so important.
Getting a Handle on Akathisia: Treatment Approaches
Right now, there isn’t one single “cure” for Akathisia. Bummer, I know. But we do have ways to manage it.
If a medication seems to be the trigger, the first thing we’ll consider is if we can switch you to a different medication or, if it’s safe to do so, lower the dose of the current one. That’s often the most effective step.
Some studies suggest certain medications might help ease the symptoms of Akathisia:
- Beta-blockers, like propranolol.
- Benzodiazepines (meds often used for anxiety or sleep).
- Low-dose mirtazapine (an antidepressant that can sometimes help with this).
- Anticholinergics (a class of drugs used for various conditions).
- Vitamin B6 has also shown some promise in certain cases.
We’ll definitely sit down and talk through all the options that make sense for you.
What’s the Outlook?
The good news is, if Akathisia is spotted early and the medication causing it can be adjusted or stopped, the outlook is generally pretty good. The restlessness often improves.
However, if it goes untreated, Akathisia can really impact your quality of life. It can lead to severe anxiety, a general feeling of unease or unhappiness (we call this dysphoria), and, as I mentioned, can even bring on suicidal thoughts. That’s why getting it checked out is key.
Can We Prevent Akathisia?
We’re still learning a lot about Akathisia. But we do know some things that seem to increase the risk:
- Using strong first-generation antipsychotics.
- Taking high doses of these medications.
- Increasing the dose too quickly or by a large amount.
- Being middle-aged or an older adult.
So, when we’re prescribing these kinds of medications, the best approach is usually to start with the lowest possible dose and increase it slowly, only if needed. And, of course, always have an open conversation with your doctor about any medication – what are the benefits, what are the risks, what side effects should you watch out for.
When Should You Talk to Your Doctor?
Simple: if you’re experiencing any of these signs of inner restlessness or an uncontrollable urge to move, especially after starting a new medication or having a dose changed, please talk to your healthcare provider. The sooner we can figure out what’s going on, the sooner we can help you feel better. Don’t just try to “tough it out.”
Take-Home Message: Key Things to Remember About Akathisia
Here’s a quick rundown of the important bits:
- Akathisia is a movement disorder causing an intense inner restlessness and a strong urge to move, often in the legs.
- It’s commonly a side effect of medications, particularly antipsychotics, but also some antidepressants and other drugs.
- Symptoms include repetitive movements like pacing, leg swinging, or shifting weight, driven by an uncomfortable internal feeling.
- It’s different from general anxiety, though it can cause significant distress and anxiety.
- Diagnosis is based on symptoms and medication history; treatment often involves adjusting the suspected medication or trying other supportive medicines.
- If you suspect you have Akathisia, talk to your doctor. Early recognition is key.
You’re not alone in this, and there are ways we can help. We’ll work through it together.