Akathisia – A terrifying condition we should be talking about.

I have been on medication for a while now – for my anxiety and insomnia. So far, I have not experienced any negative side-effects. It has only helped me cope and get better. I am one of the lucky ones.

Akathisia is a torturous condition where the sufferer feels incredibly restless and jittery. It is a movement disorder which makes it hard for you to stay still. You might feel the need to fidget all the time, walk or pace around or cross and uncross your legs. These are actions you don’t understand and can’t control.

The first description of akathisia in the medical literature appeared in 1901 when a Czech psychiatrist described a phenomenon he called “inability to sit”, i.e. a non-drug related akathisia, in two of his patients. The first report of drug-related akathisia did not appear until 1960, when three patients were reported to have developed “muscular restlessness” while taking phenothiazines. Akathisia was subsequently grouped with other anti-psychotic-induced movement disorders, including Parkinsonism and dystonia, under the umbrella of extra-pyramidal signs.

What causes akathisia?

Akathisia is a side-effect of anti-psychotic drugs which are given to clients in order to treat depression, schizophrenia, bipolar disorder etc. Not everyone taking anti-psychotics gets the disorder. The symptoms can be seen within a few days.

  1. First generation drugs are more likely to cause akathisia compared to newer ones.
  2. You’re also more likely to get it if you start with a high dose, suddenly increase your dosage exorbitantly or stop it abruptly.
  3. Drug withdrawal from illegal drugs i.e. withdrawal from opioids, cocaine, benzos etc can also cause akathisia.
  4. Certain diseases and conditions including Parkinson’s disease, traumatic brain injury and encephalitis can also be the reason.

Akathisia is highly misunderstood and is not a very well known condition. People rarely talk about it even when it was estimated at 24% and 18%, respectively in patients with schizophrenia. What makes akathisia even more distressing is the fact that it is very difficult to accurately detect it, it can be easily confused with other disorders including restless leg syndrome, persistent anxiety or agitation, and hence, it becomes difficult to treat it properly.

What are the symptoms?

I’m glad you asked, because some of these symptoms are quite vague and we might confuse them for other disorders. Akathisia usually affects your legs while you are sitting and hence, you feel the need to constantly stay in motion.

People with akathisia are likely to :

  1. Rock back and forth
  2. pace or walk around
  3. Cross and uncross their legs
  4. March in place
  5. Shift their weight from one foot to the other
  6. Squirm or fidget
  7. Grunt or moan
  8. Feel Irritated, stressed, impatient or jittery
  9. Experience Anxiety and emotional unease

You basically feel like jumping out of your skin.

More severe symptoms may include :

  1. Suicidal thoughts
  2. Violence
  3. Aggressive impulses

The following comments were posted on the internet by people about their experience of akathisia:

“I feel like I have worms crawling under every inch of my skin.”

“I can’t stop squirming, so sleep/rest is impossible no matter how exhausted I am…”

“My mouth felt like I was sucking on a battery; tingling, electrical.”

“The feeling of suffocation was worse; at the peak it felt like I was being burned alive. I couldn’t stop crying. I wanted to die, every fiber of my being wanted to be dead.”

“It was like a wave of sheer terror and panic. I would have done anything to make it stop.”

“Has anybody experienced a sense of doom from their akathisia? When I get akathisia, it feels like it’s going to last forever and stay the same or get worse, that all that is or will be good for me has gone from the world.”

How is akathisia diagnosed and treated?

Like I said, a condition like akathisia is prone to misdiagnosis but there are ways to get an idea as to what exactly is happening to your body and mind:

  • Physical exam : The doctor will examine you and ask about the symptoms. He will ask you to stand and sit for a few minutes and observe your behavior. He’ll watch for symptoms like shuffling or rocking.
  • Rating scale : Doctors also use rating scales like the Barnes Akathisia Scale to judge how severe your symptoms are and it also tracks your progress as you are treated.
  • Medical History : The doctor will ask you about your medical history, what medications you are currently taking, have you stopped taking any medications lately or started new ones. This will help them rule out other conditions with similar symptoms like:
    • Restless legs syndrome
    • Anxiety or insomnia
    • Depression
    • ADHD
    • Mania or psychosis

Here is some real good news though – akathisia almost always goes away!

Suffering from this condition can take a toll on you and the symptoms itself can magnify the fear but it will eventually go away with the right kind of diagnosis and treatment. Drug induced akathisia goes away once the medication is stopped or changed. It takes around 2-3 weeks but the condition is not permanent. Even reducing doses can make the symptoms go away in a lot of cases.

Akathisia is also a very common side-effect of anti-psychotic drugs. It effects :

  • 20% of patients on antidepressants
  • 30%-40% of patients on neuroleptics.
  • 50% to 80% of patients taking first generation antis-psychotic drugs.

So really, if you feel you’re the only one suffering from this – trust me you’re not alone. It is highly common and it will most definitely go away. I used to suffer – not from akathisia per say but a very similar condition where I felt restless all the time and I thought that this would never go away. I was terrified and thought that I would have to live with this forever. But, one month down the line and I know I was wrong.

YOU’RE GOING TO BE JUST FINE.

Some natural ways to help manage akathisia :

If you have been diagnosed with akathisia, don’t fret. Here are some ways that you can manage it while you receive the required treatment (since akathisia takes some time to go away)

  1. Changing your medications or drug dosage (will eventually make it go away)
  2. Managing depression and/or anxiety with therapy
  3. Eating a healthy diet
  4. Exercising
  5. Taking supplements like iron and vitamin B6
  6. Sleeping enough
  7. Managing stress in other ways like yoga, meditation, a support group, essential oils, herbs, etc

And finally, how can you help and what to watch out for as family and friends!

Since the key symptoms of restlessness may be invisible, close personal relations should watch out for:

  • A preoccupied appearance
  • Obvious tension
  • Quick-temperedness
  • Clear emotional distress

Now, what’s important to note is that the above symptoms could cover a wide range of other conditions that we previously talked about so ask this,

“Did the akathisia symptoms show up only after starting the medication?”
“Did the akathisia symptoms get worse after starting medication?”

Remember, an aware family member or friend can literally save a life. Use this article as a guide book to help you understand this highly common condition especially if you or your loved one is on medication.