Akathisia is a movement disorder that causes people to experience inner restlessness and constantly feel the need to move. This restlessness frequently occurs in the legs. People with akathisia suffer from repetitive movements such as pacing, rocking and swaying, fidgeting, crossing and uncrossing the legs and a general inability to sit still. Some people experience indistinct uneasiness, and many feel pain. Akathisia is a relatively common disorder doctors sometimes misdiagnose as anxiety, Tourette syndrome, parkinsonism, restless leg syndrome, dystonia, or tardive dyskinesia.
Drugs are the primary trigger of akathisia, and hundreds of medications can cause the condition. The most common culprits are older antipsychotic drugs, although antidepressants can also cause the symptoms. Newer anti-psychotic drugs are less likely to result in the condition. Experts believe lowered levels of dopamine in the brain are responsible for akathisia. Withdrawal from drugs that increase dopamine in the brain can also cause akathisia. People who withdraw from opioids, cocaine, and drugs that modify serotonin can also experience symptoms.
The symptoms of akathisia include anxiety, irritability and stress, restlessness, agitation, feeling depressed or emotionally uneasy, difficulty sleeping, unpleasant or dark thoughts, strange or aggressive impulses, and suicidal or homicidal thoughts. Understandably, these symptoms are distressing, but it can be difficult for people with akathisia to figure out what’s wrong with them.
There are four types of akathisia, categorized according to how the disorder starts and how long it lasts:
Doctors diagnose akathisia using the Barnes Akathisia Scale (BARS or BAS), which helps them determine the severity of the condition. This scale includes an assessment of subjective factors such as the patient’s awareness of their restlessness and how distressed they are by their symptoms. The objective measure consists of an observation of the physical symptoms of restlessness the patient experiences, such as the presence of rocking or pacing, and how long these symptoms occur during the period of observation.
The first port of call is to slowly lower the dose of any medication that could be causing akathisia. This must be done slowly because the sudden withdrawal of these medications can cause symptoms to worsen. Numerous medications can help in the treatment of akathisia, including beta-blockers and anticholinergic drugs.
Preventing akathisia is much more likely with newer antipsychotic medications. However, recent studies suggest there is still some risk of akathisia with these modern drugs. Ideally, people who require this type of medication will begin on as low a dose as possible, and increase slowly and only if necessary.
The prognosis for akathisia is generally good. When an individual is slowly weaned off the drug causing the akathisia, symptoms can disappear within a week. Although most akathisia will improve in this case, some people can still experience symptoms after stopping the drug. The prognosis is much better if akathisia is caught early, as ongoing physical symptoms can worsen psychotic symptoms and the prevalence of suicidal thoughts.
Akathisia is quite common, and its prevalence depends on the cause. Around 20% of people on antidepressants experience akathisia, and the rate goes up to 50 to 80% for people on antipsychotic drugs, depending on the dose. About 5% of people develop the condition when using other types of medication such as antibiotics. Unfortunately, many healthcare professionals have limited knowledge of akathisia, which leads to misdiagnosis or doctors increasing the dosage of the drugs responsible.
Awareness is key. Being aware of the causes and signs of akathisia can end suffering and save lives. It is important to watch for signs of akathisia if a friend or family member begins taking antidepressant or antipsychotic drugs. However, this is not always easy if there are no outward signs of restlessness.
Knowledgeable medical professionals can provide more information on akathisia. Online support groups enable people with the condition, and friends and family of patients to speak with others about akathisia. One such organization is the Living with Akathisia Facebook group.
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