Akathisia: Symptoms, Causes, Treatment

What are the symptoms of akathisia?

Akathisia is a condition characterized by an inner sense of restlessness and an inability to stay still. It is often a side effect of certain medications, particularly antipsychotics and some antidepressants. The symptoms of akathisia can include:

Restlessness: A strong, uncomfortable urge to move, which can manifest as pacing, fidgeting, or an inability to sit or stand still.
Movement: Repetitive movements such as rocking back and forth, crossing and uncrossing legs, or shifting weight from one foot to the other.
Physical Discomfort: An inner sense of discomfort or unease that is relieved only by moving.
Anxiety and Irritability: Increased feelings of anxiety or irritability often accompany the physical restlessness.
Difficulty Sitting Still: An inability to remain seated for extended periods, often leading to frequent standing and walking.
Sleep Disturbances: Difficulty falling asleep or staying asleep due to the constant need to move.
Fatigue: Exhaustion resulting from continuous movement and lack of restful sleep.
Emotional Distress: Feelings of frustration, distress, or depression due to the persistent restlessness and its impact on daily activities.

Akathisia can vary in severity from mild to severe and can significantly affect a person’s quality of life. If you suspect you or someone else is experiencing akathisia, it is important to seek medical advice, as adjustments to medication or additional treatments may be necessary.

What are the causes of akathisia?

Akathisia is primarily caused by certain medications, particularly those that affect the central nervous system. The most common causes include:

Antipsychotic Medications: Both first-generation (typical) and second-generation (atypical) antipsychotics can cause akathisia. These drugs are used to treat psychiatric disorders such as schizophrenia and bipolar disorder. Examples include haloperidol, chlorpromazine, risperidone, and olanzapine.
Antidepressants: Some antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), can also cause akathisia. Examples include fluoxetine, sertraline, and venlafaxine.
Anti-emetic Medications: Drugs used to prevent nausea and vomiting, such as metoclopramide and prochlorperazine, can induce akathisia.
Other Medications: Certain other drugs, including some antihistamines, calcium channel blockers, and antiepileptics, can occasionally cause akathisia.
Drug Withdrawal: Akathisia can occur as a withdrawal symptom when certain medications, such as antipsychotics or benzodiazepines, are reduced or discontinued.
Parkinson’s Disease and Related Disorders: While not a direct cause, individuals with Parkinson’s disease or related disorders might experience symptoms similar to akathisia due to dopaminergic dysfunction.

The exact mechanism by which these medications cause akathisia is not fully understood, but it is thought to involve the disruption of dopamine pathways in the brain, particularly the nigrostriatal pathway, which plays a crucial role in regulating movement.

Risk factors for developing akathisia include high doses of medication, rapid dose escalation, and individual susceptibility, which may be influenced by genetic and other personal factors.

If akathisia is suspected, it is important to consult a healthcare professional to review and adjust the medication regimen, if necessary, and to explore other treatment options to manage the symptoms.

What is the treatment for akathisia?

The treatment for akathisia primarily involves addressing the underlying cause, which is often medication-related. Here are some approaches to managing akathisia:

Medication Adjustment: If akathisia is caused by a specific medication, the first step is often to adjust the dosage or switch to an alternative medication that is less likely to cause akathisia. This may involve reducing the dosage of the offending medication, switching to a different medication within the same class, or discontinuing the medication altogether under the guidance of a healthcare professional.
Anticholinergic Medications: Anticholinergic medications such as benztropine or diphenhydramine may be prescribed to help alleviate symptoms of akathisia, particularly if it is caused by antipsychotic medications.
Beta-Blockers: Medications such as propranolol or nadolol, which are beta-blockers, may be prescribed to help reduce symptoms of akathisia by blocking the effects of adrenaline in the body.
Benzodiazepines: In some cases, benzodiazepines such as lorazepam or clonazepam may be prescribed to help reduce anxiety and agitation associated with akathisia.
Other Medications: Other medications, such as certain antidepressants or antiepileptic drugs, may be used to manage symptoms of akathisia in some cases.
Non-Pharmacological Approaches: Non-pharmacological approaches such as relaxation techniques, mindfulness meditation, and physical exercise may help alleviate symptoms of akathisia and improve overall well-being.
Close Monitoring: Close monitoring by a healthcare professional is essential to assess the effectiveness of treatment and make adjustments as needed. It’s important to communicate any changes in symptoms or side effects to your healthcare provider promptly.

The specific treatment approach for akathisia will depend on the underlying cause, the severity of symptoms, and individual factors such as overall health and medication history. It’s important to work closely with a healthcare professional to develop a personalized treatment plan that addresses your needs and concerns.

Does akathisia go away?

The duration of akathisia can vary depending on factors such as the underlying cause, the specific medication involved, and individual differences in response to treatment. In some cases, akathisia may resolve on its own over time, particularly if it is medication-induced and the medication is discontinued or adjusted.

For some individuals, akathisia may persist or worsen if left untreated or if the underlying cause is not addressed. However, with appropriate treatment and management, many people experience significant improvement in their symptoms.

It’s important to consult a healthcare professional if you experience symptoms of akathisia, as they can help determine the underlying cause and recommend appropriate treatment options. It may take some time to find the most effective treatment approach, so patience and open communication with your healthcare provider are key.

In summary, while akathisia can be distressing and uncomfortable, it is often treatable, and many individuals experience relief from their symptoms with appropriate intervention.

What is the difference between akathisia and dyskinesia?

Akathisia and dyskinesia are both movement disorders that can occur as side effects of certain medications, particularly antipsychotics, but they are distinct conditions with different characteristics.

Akathisia:

Definition: Akathisia is a movement disorder characterized by an inner sense of restlessness and an inability to stay still. Individuals with akathisia often experience a compelling urge to move, which may manifest as pacing, fidgeting, or an inability to sit or stand still.
Symptoms: Symptoms of akathisia include restlessness, repetitive movements, physical discomfort, anxiety, difficulty sitting still, sleep disturbances, and emotional distress.
Onset: Akathisia typically develops within days to weeks after starting or increasing the dosage of certain medications, particularly antipsychotics and some antidepressants.
Causes: Akathisia is primarily caused by certain medications, particularly those that affect dopamine pathways in the brain. It is thought to involve dysfunction of the nigrostriatal pathway, which plays a role in regulating movement.

Dyskinesia:

Definition: Dyskinesia refers to abnormal, involuntary movements that can affect various parts of the body, including the face, limbs, and trunk. These movements may be repetitive, jerky, or twisting in nature.
Symptoms: Symptoms of dyskinesia include involuntary movements such as grimacing, tongue protrusion, lip smacking, chewing movements, rhythmic jerking of the limbs, and twisting or writhing movements of the torso.
Onset: Dyskinesia typically develops after long-term use of certain medications, particularly antipsychotics, used to treat conditions such as schizophrenia and bipolar disorder. It may also occur in individuals with Parkinson’s disease who have been treated with levodopa or other dopaminergic medications.
Causes: Dyskinesia is primarily caused by long-term exposure to medications that affect dopamine levels in the brain, leading to alterations in the balance of dopamine signaling. It is thought to involve dysfunction of the nigrostriatal and mesocorticolimbic pathways, which regulate movement and reward processing.

In summary, while both akathisia and dyskinesia are movement disorders associated with certain medications, they have distinct symptoms, onset patterns, and underlying causes. Akathisia is characterized by inner restlessness and an inability to stay still, while dyskinesia involves abnormal, involuntary movements of the body.