From the Guidelines
Akathisia is not directly caused by stress or anxiety, though these factors may exacerbate symptoms in someone already experiencing akathisia. Akathisia is primarily a medication-induced movement disorder characterized by inner restlessness and an inability to remain still. It most commonly occurs as a side effect of certain medications, particularly antipsychotics (like haloperidol, risperidone, aripiprazole), some antidepressants (especially SSRIs like fluoxetine or paroxetine), and antiemetics (like metoclopramide) 1. The condition develops due to these medications' effects on dopamine receptors in the brain, particularly in the basal ganglia which controls movement. While psychological stress or anxiety might make someone more aware of or sensitive to akathisia symptoms, they are not the root cause.
Some studies suggest that there may be a relationship between akathisia and suicidal ideation, particularly in patients treated with SSRIs, and that akathisia may be a symptom that precedes suicidal ideation 1. However, the exact relationship between akathisia, stress, anxiety, and suicidal ideation is not fully understood and requires further research.
Key points to consider:
- Akathisia is a medication-induced movement disorder
- Stress and anxiety may exacerbate akathisia symptoms
- Akathisia is not directly caused by stress or anxiety
- Management of akathisia typically involves adjusting medication dosages or adding medications that can counteract akathisia symptoms, such as beta-blockers (propranolol), anticholinergics, or benzodiazepines 1. It's essential to consult a healthcare provider if you're experiencing symptoms of restlessness, an inability to sit still, or a compelling need to move, especially after starting a new medication.
From the Research
Akathisia and Its Causes
- Akathisia is a neurological side effect of antipsychotic medications, characterized by physical restlessness and a subjective urge to move 2.
- The pathophysiology of akathisia is not completely understood, but likely arises from complex interactions in subcortical and possibly spinal dopamine/norepinephrine systems 3.
- Akathisia has been attributed to an imbalance between dopaminergic and noradrenergic neurotransmission in the basal ganglia 4.
Relationship Between Akathisia, Stress, and Anxiety
- There is no direct evidence in the provided studies that suggests akathisia can be caused by stress or anxiety.
- However, akathisia can be a quite common and very troubling side effect of psychotropic treatment, and its symptoms can include significant distress, dysphoria, and purposeless movement 4, 3.
- The secondary complications of akathisia are numerous, including non-compliance and assaultive or suicidal ideation or behavior, which can be exacerbated by stress and anxiety 3.
Treatment of Akathisia
- Treatment of akathisia typically involves stopping the offending agent, lowering the dose, or changing to a lower potency neuroleptic 3, 2.
- Pharmacological management of akathisia may include beta-blockers, anticholinergics, benzodiazepines, and other agents 4, 3, 5, 2.
- Low-dose mirtazapine has demonstrated compelling evidence for therapeutic efficacy in the treatment of akathisia 5.