From the Guidelines
Inability to stop moving, known as akathisia, is most commonly caused by antipsychotic medication side effects, and the first line of treatment should be to lower the dosage of the antipsychotic medication or switch to another antipsychotic medication, as recommended by the American Psychiatric Association 1. The condition can also be caused by other factors such as neurological disorders, including Parkinson's disease, Huntington's disease, and restless legs syndrome, as well as psychological conditions like anxiety disorders, ADHD, and stimulant use. Key points to consider in the treatment of akathisia include:
- Medication-induced akathisia can be treated with beta-blockers like propranolol (20-40mg three times daily) or benzodiazepines like lorazepam (0.5-2mg as needed) for temporary relief, as suggested by the American Academy of Child and Adolescent Psychiatry 1.
- Neurological conditions require specific treatments, such as levodopa for Parkinson's or gabapentin (300-900mg daily) for restless legs syndrome.
- Psychological conditions may require treatment with medications or therapies targeting the underlying condition, such as SSRIs for anxiety disorders or stimulants for ADHD. The inability to stop moving occurs due to imbalances in neurotransmitters like dopamine and serotonin in the brain's movement control centers, disrupting normal motor function regulation. Prompt medical evaluation is essential to identify the specific cause and determine appropriate treatment, as emphasized by the American Psychiatric Association 1. In terms of treatment, the American Psychiatric Association recommends that patients with akathisia associated with antipsychotic therapy be treated by lowering the dosage of the antipsychotic medication, switching to another antipsychotic medication, adding a benzodiazepine medication, or adding a beta-adrenergic blocking agent 1.
From the FDA Drug Label
Because carbidopa permits more levodopa to reach the brain and more dopamine to be formed, certain adverse central nervous system (CNS) effects, e.g., dyskinesias (involuntary movements), may occur at lower dosages and sooner with carbidopa and levodopa tablets than with levodopa alone. The patient's inability to stop moving may be caused by dyskinesias, which are involuntary movements that can occur as a result of treatment with carbidopa and levodopa tablets 2.
- Involuntary movements can manifest as a range of symptoms, including uncontrollable movements of the limbs, face, or trunk.
- The development of dyskinesias is a known adverse effect of carbidopa and levodopa tablets, particularly at lower dosages and sooner than with levodopa alone.
From the Research
Causes of Inability to Stop Moving
The inability to stop moving can be caused by several factors, including:
- Akathisia, a condition characterized by restlessness and characteristic movements of the legs, often induced by dopamine blocking agents such as antipsychotics and antiemetics 3
- Restless legs syndrome (RLS), a neurological disorder characterized by the urge to move the extremities associated with paraesthesias, which are partially or totally relieved by movement 4
- Dopamine receptor blocking agents (DRBAs), which can increase presynaptic dopaminergic transmission in the ventral striatum and concomitant strong activation of postsynaptic dopamine D1 receptors 5
- Brain iron deficiency-induced down-regulation of striatal presynaptic A1 receptors, which can contribute to RLS 5
- Atypical antipsychotic agents, which can cause RLS through central dopaminergic dysfunction 6
Risk Factors
Risk factors for akathisia and RLS include:
- High dosage of antipsychotics 3
- Akathisia in a previous treatment 3
- Diabetes mellitus 3
- Genetic factors, which may play a crucial role in the development of RLS 4, 6
- Gene polymorphisms, which may be associated with antipsychotic-associated onset of RLS 6
Treatment
Treatment options for akathisia and RLS include: