Have you ever felt a strange restlessness that made you unable to stay in one position or place for even a short time? Do you feel like moving around and shaking your legs all the time with a restless feeling coming from within? This could be a side effect of a medication you are taking. Today we are going to talk about this condition (Akathisia). Don't be afraid, it is very important to be aware of this.
What is this (Akathisia)? Let's understand it simply.
Akathisia is actually a collection of symptoms related to the nervous system and mind (`(Neuropsychiatric syndrome)`). Also, it is a movement disorder. In this case, it is very difficult to sit or stay still due to a severe restlessness that comes from within. The word "akathisia" comes from the Greek language, meaning "inability to sit". This condition often occurs when using certain medications, especially `(Antipsychotic)` or `(Neuroleptic)` medications used for mental illnesses. Not only that, this (akathisia) can also be associated with certain medical conditions such as `(Parkinson's disease)`. A person with (akathisia) feels a great restlessness and restlessness inside. This is why they have a great desire to move around constantly, especially to move their legs. Often these movements are done in the same way over and over again (`repetitive`). This uncontrollable urge to move can be very distressing. Doctors divide this condition (akathisia) into several types, depending on when the symptoms start and how long they last.
- Acute akathisia: This usually occurs in the first few days after starting a medication, especially an antipsychotic, or when the dosage is increased. It lasts for less than six months.
- Chronic akathisia: This type of akathisia occurs when symptoms last for more than six months. It can last for months or even years.
- Tardive akathisia: This occurs after starting certain medications, increasing the dosage, or even three months later. It is often associated with another movement disorder called tardive dyskinesia.
- Withdrawal akathisia: This condition can occur when the dosage of some medications is reduced or completely stopped.
Is Akathisia the same as Anxiety?
No, don't confuse the two. Akathisia and anxiety are two different conditions. Akathisia is a movement disorder, while anxiety is a mental health condition. However, they may share some common characteristics. For example, restlessness, and an inability to control one's thoughts and behavior. However, the main feature of akathisia is an uncontrollable urge to move constantly. Symptoms that are based on fear or anxiety are rare. However, it is common for people with akathisia to feel anxious and stressed because of this uncontrollable urge to move.
Unfortunately, the condition (Akathisia) is often misdiagnosed as persistent anxiety and/or agitation.
How common is Akathisia?
Akathisia is the most common movement disorder associated with psychotropic medication, especially antipsychotic medication. It is estimated that up to 24% of people with
schizophrenia who take medication for the disorder have akathisia. In one study, 39% of people taking clozapine and 45% of people taking first-generation antipsychotics (FGA) had akathisia.
What are the symptoms of (Akathisia)?
Akathisia symptoms usually appear after you start taking an antipsychotic medication, or after your doctor increases the dose. The main symptom is
a feeling of restlessness, or jitteriness . People with akathisia feel an overwhelming urge to shake their body, especially their legs, from their hips to their ankles. If you have akathisia, you can do these things:
- I always cross my legs and then straighten them again.
- My legs keep moving while sitting.
- When standing, you transfer weight from one leg to the other.
- I sway back and forth while sitting.
- They are constantly walking back and forth, or standing in one place and pretending to march.
To someone else, these signs and movements may seem like someone who is constantly fidgeting and can't sit still.
If you have these symptoms, it's important to talk to your doctor as soon as possible. How does it feel when you have (Akathisia)?
People with Akathisia often describe feeling a strong inner restlessness and an uncontrollable urge to move. They often describe feeling restless and unable to relax. They may also feel tense when they need to stay still, such as in a queue. This inner restlessness often causes people with Akathisia to experience anxiety and depression. Prolonged Akathisia states,
It has been linked to an increased risk of self-harm or suicidal behavior. If you are having suicidal thoughts or feel like harming yourself, it is essential to seek medical help immediately.
What are the causes of Akathisia?
Scientists still don't know the exact cause of akathisia. But they think it's because some medications block the receptors in the brain that receive a chemical called dopamine. Dopamine is a neurotransmitter, a chemical that helps with many important bodily functions, including our movement. This blockage causes the uncontrolled movements. There are several medications that are associated with akathisia: Akathisia is also associated with certain health conditions:- Parkinson 's disease.
- Brain infection/ inflammation (`Encephalitis`).
- Head injuries (Traumatic brain injury - TBI).
Antipsychotic medications associated with Akathisia
Akathisia is the most common movement disorder associated with antipsychotic medications. Doctors sometimes call it antipsychotic-induced akathisia. Antipsychotic medications, or neuroleptics, fall into two main categories:- First generation or "typical" antipsychotics (FGA).
- Second generation or "different" `(Antipsychotics - SGA)`.
Akathisia is most commonly associated with medications in the `(FGA)` class, especially those that are more potent and are used in higher doses. The risk is somewhat lower with `(SGA)` medications. Doctors prescribe these `(FGA)` and `(SGA)` medications for a variety of neuropsychiatric conditions. For example:- Behavioral disturbances in dementia.
- Bipolar disorder.
- Depression.
- Eating disorders.
- Generalized anxiety disorder.
- Insomnia .
- Obsessive-compulsive disorder (`Obsessive-compulsive disorder -OCD `).
- Personality disorders.
- Post-traumatic stress disorder (PTSD).
Schizoaffective disorder. Schizophrenia and related disorders.
Examples of some FGA medications (with brand names) that may be associated with Akathisia:- ``Chlorpromazine (Thorazine®)''
- `Fluphenazine (Prolixin®)`
- `Haloperidol (Haldol®)`
- `Loxapine (Loxitane®)`
- ``Prochlorperazine (Compro®, Compazine®)''
Some of the SGA medications that are at increased risk for Akathisia include:- `Paliperidone (Invega®)`
- `Ziprasidone (Geodon®)`
Although not as common as antipsychotic medications, some antidepressants have also been linked to akathisia. These include:- Selective serotonin reuptake inhibitors (SSRIs): These are the most commonly prescribed antidepressants. Examples: fluoxetine (Prozac®), paroxetine (Paxil®).
- Monoamine oxidase inhibitors (MAOIs): These were the first antidepressants to be developed. Although they were effective, newer, safer medications with fewer side effects are now often used.
- Tricyclic (TCA) antidepressants: Doctors prescribe these when other antidepressants don't work. Examples: clomipramine (Anafranil®), amitriptyline (Elavil®).
Doctors prescribe antidepressants for conditions like:- Depression.
- Bipolar disorder.
- Anxiety disorders.
- Chronic pain.
- Obsessive-compulsive disorder (OCD).
- Panic attacks.
- Post-traumatic stress disorder (PTSD).
It is estimated that between 10% and 18% of people with bipolar I disorder who take antidepressants develop akathisia. Other medications associated with Akathisia
Other medications that may be associated with Akathisia:- Medicines for nausea or vomiting (antiemetics), e.g. metoclopramide.
- Medicines for high blood pressure, e.g. `reserpine`, `methyldopa`.
- Calcium channel blockers, e.g. cinnarizine, diltiazem.
- Sedatives.
- Medicine for dizziness.
- `Azithromycin` (a widely used antibiotic).
- `Buspirone` (an anxiety medication).
Akathisia can also be caused by illegal drugs such as amphetamine, methamphetamine, and cocaine. How to recognize (Akathisia)?
Doctors usually diagnose Akathisia by observing the patient's behavior and symptoms (`clinical observation`). This does not require blood tests or imaging tests. The most common method used to assess the level of Akathisia is the ``Barnes Akathisia-Rating Scale (BARS)``. If you think you have Akathisia, your doctor will ask you questions about your symptoms, medical history, and current medications. They will also observe your behavior and movements. Unfortunately, Akathisia is often difficult to diagnose. Because its symptoms are similar to other mental health conditions, for example:- Psychosis.
- Mania.
- Attention-deficit/hyperactivity disorder (ADHD).
- Agitated depression.
How is Akathisia treated?
There is currently no specific treatment for Akathisia. If your Akathisia is caused by a medication, your doctor will likely try to switch you to another medication or reduce the dose of the medication you are currently taking (if possible). Some studies have shown that the following medications may help with Akathisia:- Beta-blockers, for example propranolol.
- Benzodiazepines (a class of medications used to treat conditions such as anxiety, insomnia, and seizures).
- Low-dose mirtazapine (an antidepressant).
- Anticholinergics (a type of medicine used to treat conditions such as asthma).
- Vitamin B6.
Can Akathisia be prevented?
Scientists are still trying to fully understand Akathisia, its causes, and treatments. But they do know that Akathisia is more likely to develop in the following situations:- If you are taking a first-generation antipsychotic medication.
- If you take too much medicine.
- If your doctor suddenly increases the dosage of your medication, or significantly.
- If you are middle-aged or elderly.
Given these facts, the best way to prevent Akathisia is for doctors to start these medications at the lowest possible dose and gradually increase the dose if necessary. Before starting any medication, it is important to talk to your doctor about the risks, benefits, and possible side effects. What is the prognosis of (Akathisia)?
If Akathisia is recognized early and the medication causing it is stopped (if possible), the condition usually improves. However, if Akathisia is left untreated, it can be very debilitating. Many people with Akathisia experience severe anxiety and depression (`dysphoria`). They may even have suicidal ideations. If you are having suicidal thoughts, it is essential to seek medical help immediately.
When should you see a doctor about (Akathisia)?
If you have symptoms of Akathisia, it's important to talk to your doctor. The sooner they can find the cause, the sooner they can change your medication and get the condition under control. Akathisia is a very annoying side effect that can be caused by some medications. If you're worried that you might develop Akathisia after starting medication for a mental health condition or neurological disorder, don't be afraid to ask your doctor about it. If you have symptoms of Akathisia, tell your doctor as soon as possible. The most important things to remember (Take-Home Message)
- Akathisia is a condition in which an inner restlessness causes an inability to stay in one place and a constant urge to move.
- This can be caused mainly by some antipsychotic medications. It can also be caused by antidepressants and other medications.
- Symptoms include shaking legs, walking around, and an inability to stay in one place.
- This is not anxiety, but it can cause anxiety.
- If you have these symptoms, be sure to tell your doctor. This condition may be managed by changing the dosage of your medication or switching to a different medication.
- Never stop taking your medication or change the dosage without your doctor's advice.
- Akathisia can be reversed if diagnosed and treated early.
If you have any further questions about this, don't hesitate to talk to your doctor. Stay healthy!
💬 Comments (0)
No comments yet. Be the first to share your thoughts here.
Add Your Comment