Akathisia

Medically Reviewed by Smitha Bhandari, MD on January 12, 2023
Written by Sharon Liao
4 min read

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, walk in place, 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.

Not everyone taking an antipsychotic drug gets the disorder. Symptoms usually appear within a few days. Older, first-generation versions of these drugs are more likely to cause akathisia than newer ones. You’re also more likely to get it if you start with a high dose, suddenly increase the dose, or stop a medicine suddenly.

Older antipsychotic drugs that may cause akathisia include:

Doctors aren’t sure exactly why these drugs have this side effect. They may block chemicals like dopamine that help your brain cells talk to each other. In parts of your brain that control movement, dopamine plays an important role in muscle control.

Other medications can also bring on akathisia. They include:

  • Drugs used to prevent vomiting and nausea
  • Antidepressants like tricyclics and selective serotonin reuptake inhibitors (SSRIs)
  • Calcium-channel blockers

So can health conditions like:

 

The main sign of akathisia is a sense of restlessness and intense need to move. To relieve this feeling, you need to stay in motion. It usually affects your legs, usually while you’re sitting. People with akathisia are likely to:

  • Rock back and forth
  • Pace or march in place
  • Shift their weight from foot to foot
  • Cross and uncross their legs
  • Squirm or fidget
  • Grunt or moan

Other symptoms include feeling irritable, stressed, impatient, or panicked. You may feel like jumping out of your skin.

What kind you have depends on when you get the condition.
 

  • Acute akathisia shows up soon after you start a medication. It lasts for less than 6 months.
  • Chronic akathisia lasts for 6 months or more.
  • Tardive akathisia may not show up until months or years after you take a medicine.
  • Withdrawal akathisia usually sets in within 6 weeks after you switch or stop an antipsychotic drug.

 

It’s important to see your doctor if you have symptoms of akathisia. If left untreated, it can lead to distress, disruptive behaviors, or sometimes even suicidal thoughts. Don’t stop taking medications unless your doctor says it’s OK.

  • Physical exam: Your doctor will check your body. You’ll also sit and stand for a few minutes. They’ll watch for symptoms like rocking or shuffling. They may fill out a rating scale like the Barnes Akathisia Rating Scale to judge how severe your symptoms are and track your progress as you’re treated.
  • Medical history: The doctor will ask about your medical history, what medications you’re taking, and other conditions you have. This will help rule out other conditions that can cause similar symptoms:
    • Restless legs syndrome also causes an uncontrollable urge to move your legs, but mostly at night. You could also have leg pain.
    • Tardive dyskinesia is a side effect of antipsychotic drugs. It causes movements you do over and over, like blinking and grimacing. But you don’t have control over them. With akathisia, you make the choice to move to relieve an urge.
    • Anxiety or insomnia. Because akathisia makes you feel restless and uneasy, it’s easy to mistake it for these conditions.
    • ADHD, agitated depression, mania, or psychosis, which all have similar symptoms.

 

In most cases, your doctor will change your medicine. They may lower your dose or switch to a drug that’s less likely to cause akathisia. They may also prescribe a medicine to treat your symptoms. Medications used to treat akathisia include:

  • Beta-blockers like propranolol: These blood pressure medicines are usually the first treatment that doctors prescribe for akathisia.
  • Benzodiazepines: These anti-anxiety medications are recommended only for short-term use.
  • Anticholinergics: Doctors use these drugs less for akathisia and more for movement symptoms caused by antipsychotic medicines, like muscle stiffness or certain kinds of tremor.
  • Certain antidepressants, like mirtazapine or trazodone: At low doses, these drugs relieve akathisia symptoms.
  • Drugs for Parkinson’s disease, like amantadine: These medicines may boost your dopamine levels in parts of your brain that control movement. This can ease akathisia and other muscle symptoms of antipsychotic drugs.
  • Vitamin B6: High doses could ease akathisia symptoms.

 

Once your doctor lowers your medication dose or finds the proper treatment, akathisia will usually go away. For a small group of people, it might last for 6 months or more. Or it could turn into tardive akathisia.

To prevent akathisia, your doctor should start you with a low dose of antipsychotic medication and gradually increase the amount over time.