Akathisa, also spelled acathisia, is a medical term used to describe “inner restlessness,” often in response to taking certain types of medications designed to treat psychiatric conditions. It may also occur in people with certain disorders like Parkinson’s disease, or be the result of certain conditions like the manic or hypomanic phase of bipolar I and II. Often, akathisia is linked to use of antipsychotics, but recent studies also link it to use of some anti-depressants of the SSRI class (selective serotonin reuptake inhibitors). Some doctors suggest that akathisia resulting from SSRI use may be creating greater suicidality among patients who experience it.
Inner restlessness can be interpreted in a lot of ways. Some people feel mild or moderately anxious or tense. Akathisia often expresses itself as a feeling that you just can’t sit still, and severe cases can mean a person must move around, or becomes extremely weepy, has panic attacks, can’t sleep, and may not even be able to lie down to get to sleep. If you can consider a time when you were extremely anxious, worried or restless about things, imagine feeling this for an extended period of time. If you’ve ever paced a hospital floor waiting for bad or good news about a sick or ailing loved one, or have been so nervous about something you couldn’t sleep, you’d have a good sense of what akathisia feels like. The main difference for people with the condition and those who experience the occasional bout of extreme worry or restlessness is that this condition is relentless and unremitting.
Studies on SSRIs suggest that some people develop the condition when given SSRIs. In this state, people are more likely to kill themselves or to try than they are when they are in a depressed state. They feel they must do something to make the restlessness stop, because there isn’t a single second of rest from it.
Unfortunately, some medications, especially medications used to treat conditions like schizophrenia, dissociative disorder or the delusions associated with manic depression, may worsen akathisia. A host of drugs called neuroleptic antipsychotics list this as a common side effect. These include medications like haloperidol, clozapine, trazadone, perphenazine, and chlorpromazine, to name just a few. If you are prescribed a neuroleptic antipsychotic drug, or have begun taking an SSRI, do ask your doctor which symptoms you should look for, so you can quickly get help if you begin to experience them.
Not all people get this condition from SSRIs or neuroleptic antipsychotics, but many do develop these symptoms, particularly when taking antipsychotics. This can sometimes be disastrous without the right doctor, because akathisia may be misdiagnosed as a greater manifestation of psychotic symptoms. Instead of stopping a medication creating the problem, more of the same medication may be prescribed, which will greatly worsen the condition.
The main treatment for akathisia is to stop or lower the levels of the drug suspected of creating the problem. Other treatments that can help are medication with things like certain tranquilizers or even antihistamines. With more knowledge about this difficult condition, which in its worse manifestations is torturous to endure, it is hoped that patients encountering it will get appropriate and immediate treatment. If you find yourself experiencing these symptoms, do contact your doctor or psychiatrist immediately and ask if akathisia may be prompting these feelings.