From the Guidelines
Akathisia is not directly caused by stress or anxiety, but rather is primarily a side effect of certain medications, and stress or anxiety may exacerbate its symptoms. The condition of akathisia is most commonly associated with the use of antipsychotic drugs, certain antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), and antiemetics 1. According to the practice parameter for the assessment and treatment of children and adolescents with suicidal behavior, there have been reports that SSRIs may have a disinhibiting effect, especially in patients with SSRI-induced akathisia, which could potentially increase suicidal ideation in a small number of adults not previously suicidal 1.
Key points to consider about akathisia include:
- It manifests as an intense inner restlessness and a compelling need to move, often described as an inability to sit still.
- The condition has a distinct neurological basis related to dopamine blockade in the brain.
- Anxiety can produce restlessness that might appear similar to akathisia, but true akathisia has a different underlying cause.
- If experiencing restlessness that might be akathisia, it's crucial to consult with a healthcare provider, especially if there have been recent changes in medications.
In terms of management, treatment typically involves:
- Adjusting medication dosages
- Switching to alternative medications
- Adding medications like beta-blockers or benzodiazepines to manage symptoms, although these should be prescribed with caution due to their potential to increase disinhibition or impulsivity 1.
From the Research
Akathisia Causes
- Akathisia is a movement disorder that can be caused by various factors, including antipsychotic medication 2, 3, 4, 5, 6
- The exact pathophysiology of akathisia is not completely understood, but it is likely related to complex interactions in subcortical and possibly spinal dopamine/norepinephrine systems 6
- There is no direct evidence to suggest that stress or anxiety can cause akathisia, but it may be a contributing factor in some cases
Treatment Options
- Treatment of akathisia typically involves reducing the dose of the offending medication, switching to a different medication, or adding adjuvant medications such as beta-blockers, anticholinergics, or 5HT2A antagonists 2, 3, 5
- Other treatment options may include benzodiazepines, vitamin B6, or other medications such as opiates, amantadine, or buspirone 3, 5, 6
- A personalized treatment approach is recommended, taking into account the individual patient's symptoms, medical history, and response to treatment 5
Assessment and Diagnosis
- Akathisia can be assessed using validated scales, and clinicians should systematically evaluate patients for akathisia before starting antipsychotics and during dosage titration 5
- Distinguishing akathisia from other movement disorders, such as tardive dyskinesia, is crucial for providing effective treatment 6