Akathisia

Standing on road

What is akathisia?

Akathisia is a movement disorder that makes it hard for you to stay still. It causes an urge to move that you can’t control. You might need to fidget all the time, pace, or cross and uncross your legs. Usually, akathisia is a side effect of antipsychotic drugs. You take these medicines to treat schizophrenia, bipolar disorder, and other brain conditions. That means your doctor can change your medicine or dose to relieve your symptoms of akathisia.

What causes akathisia?

Experts aren’t exactly sure what causes akathisia, but akathisia is most commonly caused by antipsychotic drugs, particularly first-generation medicines such as chlorpromazine, droperidol, fluphenazine, haloperidol, prochlorperazine, and thioridazine. These drugs block chemicals such as dopamine that play an important role in movement and muscle control.

However, not everybody who takes these drugs develops akathisia. The risk is increased in people taking high dosages, or who have a sudden dosage increase or stop their dosage suddenly. Other medicines that can cause akathisia include:

  • Medications that prevent nausea and vomiting, such as metoclopramide
  • Antidepressants, such as tricyclics and selective serotonin reuptake inhibitors (SSRIs)
  • Calcium-channel blockers.

Akathisia is also a feature of some medical conditions such as Parkinson’s disease, traumatic brain injury, and encephalitis.

What are the symptoms of akathisia?

The main feeling of akathisia is a feeling of having to constantly move that is uncontrollable. Other symptoms may include:

  • Constantly fidgeting or squirming
  • Crossing and uncrossing legs or shifting weight from foot to foot
  • Grunting or moaning
  • Inability to sit still
  • Irritability or feeling stressed or panicked
  • Pacing or marching in place
  • Rocking back and forth.

There are four main types of akathisia:

  • Acute akathisia: Develops soon after initiation of a medicine, lasts for less than 6 months
  • Chronic akathisia: lasts for longer than 6 months
  • Tardive akathisia: Develops months or years after initiation of a medicine
  • Withdrawal akathisia: Sets in within 6 weeks of switching or stopping an antipsychotic.

How is akathisia diagnosed?

See your doctor if you have symptoms of akathisia. Treatment may be as simple as changing to a different medication after a discussion with your doctor. Left untreated, akathisia can lead to disruptive behaviors and sometimes suicidal thoughts.

Your doctor will take your medical history and perform a physical exam. They will ask you about movement-related symptoms and may fill out a rating scale like the Barnes Akathisia Rating Scale to judge the severity of your symptoms and track your progress as you’re treated. They may perform other tests to rule out other conditions that have similar symptoms.

How is akathisia treated?

Akathisia is usually treated by changing the most likely causative medicine to one that is less likely to cause akathisia. Other medications may be prescribed to treat the akathisia, such as:

  • Anticholinergics
  • Antidepressants such as mirtazapine or trazodone
  • Beta-blockers
  • Benzodiazepines
  • Drugs for Parkinson’s disease
  • Vitamin B6.