What is Akathisia?
Akathisia is a condition where a person can’t stay still and feels profoundly restless, typically involving their lower body. This restlessness often results in repetitive movements, such as crossing and uncrossing their legs, swinging, or shifting from one foot to the other. To others, it may look like they are constantly fidgeting.
This movement disorder is usually linked to the use of antipsychotic medications. Other movement difficulties that can be triggered by these medicines are acute dystonia, pseudoparkinsonism, and tardive dyskinesia. Akathisia can also sporadically happen with antidepressants. It tends to occur shortly after starting the antipsychotic medication or when the dosage is increased.
In recent times, akathisia has been associated with other types of medications as well, such as those used for high blood pressure (calcium channel blockers), nausea (antiemetics), vertigo, and strong medications used for anesthesia. Even misuse of drugs like cocaine has been known to cause akathisia. The symptoms of this condition can emerge abruptly or over time and can last for a few months or even years.
What Causes Akathisia?
Akathisia is a condition we don’t fully understand yet, but we think it may be connected to the use of drugs used for treating severe mental illness, known as antipsychotic agents. These drugs block specific places in the brain, called dopamine type-2 receptors.
There’s a general idea that the cause is an imbalance between either cholinergic/dopaminergic or serotonergic/dopaminergic systems. These are systems in our bodies that control various functions. This imbalance likely happens in a part of the brain called the shell of the nucleus accumbens, which plays a big role in our reward system.
Risk Factors and Frequency for Akathisia
Akathisia, a condition that can occur as a side effect of certain medications, varies in how often it happens. It’s more likely to occur with the first-generation (also known as ‘typical’) antipsychotics, especially stronger ones like haloperidol. However, it is less common with second-generation (or ‘atypical’) antipsychotics.
Signs and Symptoms of Akathisia
Akathisia is a condition that often appears in patients who have recently started using an antipsychotic drug or had their dosage increased. Normally, it manifests within the first two weeks of starting the medication. People dealing with akathisia generally experience a strong need to move or restlessness, which can often be seen physically as they may pace around, rock back and forth, or persistently change positions, causing them to feel distressed and uncomfortable.
Medical professionals assess the severity of akathisia using aids like the Barnes Akathisia Rating Scale (BARS). It’s crucial for them to understand that the inner restlessness akathisia causes can lead to extreme anxiety and sadness in the person suffering. Frequent cases of akathisia have even been tied to a higher chance of self-harm or suicidal actions. Because of this, doctors should always check for a history of depression, anxiety, and suicidal thoughts.
Testing for Akathisia
The Barnes Akathisia Rating Scale is often used to check for a condition called akathisia. However, usually, doctors just observe the patient’s symptoms to diagnose this. There aren’t any lab tests or scans that can confirm a diagnosis of akathisia.
Treatment Options for Akathisia
When a patient experiences akathisia, or restlessness, as a result of taking antipsychotic medication, it can be managed in a few different ways. One option is reducing the medication dose or switching to a different type of antipsychotic medication.
Historically, two types of medications have been used to treat akathisia: beta-blockers, like propranolol and benzodiazepines. Another type of medication called anticholinergic agents can be used, particularly if the patient is also showing signs of pseudoparkinsonism, a condition that looks like Parkinson’s disease. It’s important to note, though, that the evidence supporting their effectiveness isn’t very solid.
Mirtazapine, an antidepressant, can also be used to manage akathisia. Studies have shown that low doses of mirtazapine can be as effective as beta-blockers, making it another possible first-line of treatment. However, it should be used carefully, as there have been cases where high doses have made akathisia worse.
Beta-blockers come with a risk of slow heart rates and low blood pressure, which doctors need to be mindful of.
There are also other substances, such as vitamin B6, that have been used to treat akathisia. However, we don’t have enough high-quality, randomized trials to confirm whether these are effective treatments.
What else can Akathisia be?
Akathisia, which manifests as restlessness and an inability to sit still, is frequently not identified correctly. This is because its signs may look like those of other mental health conditions such as extreme mental disturbance, exhibiting overly excited behavior, Attention Deficit Hyperactivity Disorder (ADHD), or intense feelings of restlessness or agitation associated with depression. As such, it’s crucial to acquire a comprehensive health history and ensure that other mental health disorders aren’t mistaken for it.
What to expect with Akathisia
The prognosis is favorable if the condition is identified and the drug causing it is stopped. However, if the condition isn’t addressed, it can greatly affect a person’s health and may even cause thoughts of suicide.
Possible Complications When Diagnosed with Akathisia
Akathisia is a serious condition that can significantly interfere with a person’s day-to-day life if it’s not identified and treated. Many people afflicted with it experience intense feelings of anxiety and unhappiness. There are even recorded instances of people with this condition having thoughts of suicide.
Preventing Akathisia
In cases where akathisia is present, changes may have to be made to the medication treatment plan. This could involve adjusting the way the medication is administered or reducing the dose to help stop the akathisia.
