Akathisia INFO


This blog entry is for people who are wondering what the cause is for their anxious suffering. I have put together this information to educate people who may be suffering from drug-induced Akathisia and the people who care for them. I believe strongly with as many prescriptions that are written these days for psychotropic medication (antidepressants, antipsychotics) that consumers, as well as those in the helping professions (such as doctors, nurses, EMT’s, psychologists, psychiatrists, counselors, and the like) need to be aware of the risk of Akathisia.

I am not a doctor. I’m just a consumer interested in helping educate other consumers.

The information I provide for you here is in no way exhaustive, nor is it meant to replace medical care. It is here as a support and to help guide you to figure out if this may be what you’re going through, so you can take the next appropriate steps.

I believe there is a lot of preventable suffering and even preventable suicides that have happened because people simply don’t realize what they are going through is an actual syndrome and that it will go away once they stop taking the offending medication and their brain gets back in balance. You see, when Akathisia hits most people have no clue that such a reaction even exists, so they think it’s just that they’re going crazy. In assuming that, they believe it’s only going to get worse and in steps hopelessness and a compounding of the terror they are already feeling.

Akathisia is almost always a physiological and physiological response to a medication. It can either be due to the introduction of a medication or come about in response to withdrawal from medication. It can last anywhere from a few hours to several months, depending on the drug, how long the drug was taken and the person’s pre-existing condition.

What are some of the main symptoms of Akathisia?

  • Extreme agitation/restlessness
  • Inability to sleep/insomnia
  • Profound anxiety/terror/panic
  • Feeling like you’re jumping out of your skin or want to rip your skin off and escape
  • Feeling a need to run away
  • Agoraphobia/claustrophobia
  • Dark, scary thoughts
  • Psychotic-type behaviors
  • Anger/aggression
  • Self-harm or thoughts of self harm
  • Inability to sit still or lie down
  • Feeling like it will never end
  • Muscular tension/strain/weakness/ticks
  • Blurred vision
  • Loss of appetite
  • Confusion
  • Memory loss/amnesia
  • Nausea/retching/vomiting
  • Flushing/hot flashes
  • Erratic heart beat
  • Erratic blood pressure
  • Extreme, chronic thirst

Medications that may cause Akathisia*:

  • Anti-emetic (anti-nausea) medications, such as;  Compazine (prochlorperazine), Reglan (metoclopramide).
  • Antibiotics (Various)
  • SSRI anti-depressants, SNRI anti-depressants and hypnotic anti-depressants, such as;  Prozac, Rapiflux or Sarafem (fluoxetine) and Paxil or Seroxat (paroxetine), Desyrel, Beneficat, Deprax, Desirel, Molipaxin, Thombran, Trazorel, Trialodine or Trittico (trazodone), Effexor, Efexor or Trevilor (venlafaxine) and Zoloft or Lustral (sertraline hydrochloride)..
  • Opioid withdrawal.
  • dexamethasone, prednisone, hrdrocortisone , betamethasone, triamcilone.
  • ALSO – Many natural substances may cause reactions as severe as Akathisia as well. The ones noted for helping with anxiety and depression seem to be the biggest offenders. Vitamins, herbs and supplements such as: Vitamin D, 5HTP, SAMe, Fish Oil, St. John’s Wart, Gingko Biloba, etc. Be cautious and thoughtful even when taking naturally derived supplements. Add only one at a time to your diet and watch closely for any reactions. If you feel you may be reacting poorly, STOP taking the offending supplement. Period.

And as a further note, some drugs and some natural supplements may feel great while you’re taking them then only once you try to stop taking them will you react badly or encounter Akathisia. The brain is a very complex structure, and I’m not a doctor, so I cannot explain the hows and whys, I only know that all of these things are possible and we (as consumers) must be proactive, careful and methodical when endeavoring to take or titrate off ANY substance. The doctors will not admit their precious drugs are a problem, drugs are their business. You have to look out for YOU.

*Please understand this list is not exhaustive, as people react differently to different types of medications. These are just the most well known for the potential to cause Akathisia. (If you can help me add to the list feel free to email me.)

Often times what happens is, a person is given one of these medications, they have a reaction (within minutes, days, weeks or even months, it totally varies per medication and individual) and they don’t correlate the reaction (Akathisia) to the medication. What they think is, “I was put on this medication because I’m mentally unstable and now I’m getting worse”. Then they end up getting the dosage upped, or other medications are added, and the Akathisia gets even worse! This is where many people lose hope and resign to a life of intolerable suffering or they decide they can’t handle it and sadly, end their lives.

The other common occurrence is, someone gets put on a medication for depression, anxiety or some other mental issue, eventually they decide to try life without the meds or are feeling much better and they decide to come off the medication. Then within days or months they have a withdrawal onset of Akathisia and because they aren’t aware of this possible reaction, they think the problem is organic and they assume they are not okay without the drug, so they go back on it and get caught up in an endless loop of Akathisia reactivity.

Sadly, many of the prescribing physicians aren’t fully aware of, or willing to admit, the prevalence of Akathisia so they unwittingly make things worse with misinformed advice and often times even more prescriptions being written, which compounds the problem.

For the lucky ones, such as myself, they are given a medication for something not related to mental health issues (for example, anti-nausea medication), so they quickly realize the connection between their distress and the medication.

Many anti-nausea medications are actually anti-psychotics and they mess with the functioning of important brain chemicals. Most people given such medications, like Compazine, are unaware of this. And most that do find out after the fact state if they had known they were being given something that could potentially mess with their brain they would have happily opted to keep the nausea and forgo the risk of Akathisia.

One of the most common situations where this happens is when someone is treated for nausea or migraines with one or more of these offending medications. Then, of course, people who are being treated for anxiety and/or depression or other mental/personality disorders with one or more of these medications.

So, if you have been treated with medication(s) for anxiety, depression, migraines, nausea, psychotic episodes, schizophrenia, bi-polar disorder or other mental/emotional disorders and you have found yourself suffering one or more of the symptoms listed above then please read on…

What can you do?

First and foremost, I have to say if you think you may be suffering an Akathisia reaction to a medication/medications please contact your doctor.  If they don’t seem to believe you, or understand what you’re talking about, just call around until you find a doctor that has their head on straight that understands what you’re going through. If they don’t understand or don’t react with integrity and empathy they won’t be of any help anyway. So find someone who KNOWS WHAT AKATHISIA IS.  Don’t waste your time trying to convince a closed-minded doctor that you’re having a drug reaction. It seems many doctors just don’t, or won’t, get it. (Neurologists seem to have the most experience with, and understanding of, Akathisia. You may want to find a psychopharmacologist as well, or a neuropsychiatrist.)

If Western Physicians are of no help, I highly recommend finding a naturopath/holistic doctor. They are much more willing to admit that pharmaceuticals are dangerous and to help you find good, clean ways to detox and get back in balance.

All medications and supplements should be used under the care of a physician.

Please understand I’m in no way affiliated with ANY pharmaceutical or natural supplement companies, I’m only listing this information I’ve learned to help you make informed decisions to help yourself navigate and overcome Akathisia.

The information I’m giving you here is simply things I learned that has worked for people or  worked for me. There aren’t any medications that I’m aware of that will alleviate Akathisia for everyone. It’s hit and miss to find something that works and many people find no relief with pharmaceuticals. Akathisia simply hasn’t been studied enough for them to know truly how and why it happens. It manifests differently for different people and the recovery is different for everyone. BUT, there are many similarities for a lot of folks and some basic things you can do to help your body detox and get back in to balance.

I’m going to give you info on medications that may help, if you want to try that route and also info on natural ways to help alleviate the symptoms of Akathisia and get your body moving back toward homeostasis. SOME SAY GETTING YOUR BODY AS CLEAN AS POSSIBLE IS REALLY THE QUICKEST WAY TO RESOLVE AKATHISIA, WHICH MEANS TAKING THE LEAST AMOUNT OF MEDS/SUPPLEMENTS POSSIBLE. I can’t give medical advice, but after all the research I’ve done and people I’ve talked with as they have gone through the healing process, I’ll just say, I pretty much agree.

Medications that may help alleviate some of the symptoms/shorten the duration of Akathisia*:

  • Anti-histamines, such as;  Benadryl (diphenhydramine), Periactin (cyproheptadine).
  • Cogentin (benztropine)
  • **Benziodiazepines, such as;   Xanax (alprazolam), Ativan (lorazepam), Valium (diazepam).
  • Beta-blockers, such as;  propranolol, metoprolol.
  • Artane (trihexyphenidyl)

*Since initially writing this section more than 5 years ago, I have learned these meds can actually cause or worsen akathisia for some. The ONLY ONE I’ve never heard of causing things to get worse is Propranolol.

**Benzodiazapines are VERY addictive to both body and mind, so use caution and wean off of them slowly with the help of a physician as your symptoms improve.

High doses of Benadryl is the first course of action for treatment of Akathisia almost anywhere you go. (It won’t really help if you’re still on the offending med though. It’s more for people who have discontinued the offending med.) It does help lessen or stop Akathisia for many people, so it’s definitely worth a try (UNLESS you know you are allergic to it, in that case other meds need to be tried. I’ve heard of a few people even having success with Claritin, which is also available over the counter and usually well tolerated, so it could be worth a try.) If you go to the ER they will likely give you a very large amount of Benadryl for the treatment of Akathisia, but if you’re doing it at home please treat yourself with a reasonable dosage. The ER nurse told me to take 50mg every 4-5 hours, for a few days. Even if you are feeling relief from the first dosage some say you need to carry on with treatment for a few days, to prevent relapse.

Supplements/Herbs  that may help alleviate the symptoms/shorten the duration of Akathisia and detox:

  • B-Complex (Pref a whole food vitamin), B-6
  • High doses of Vitamin C (I personally find Emergen-C to be well assimilated and tolerated)
  • Natural CALM (THIS HELPED ME MORE THAN ANYTHING, PLEASE GIVE IT A TRY)
  • Decaf green tea
  • Green drink (I personally like “Greens First” over all other brands)
  • Chamomile tea
  • Bach Rescue Remedy

Things you can do to help soothe and detoxify the body and boost your good brain chemistry:

  • Drink plenty of water
  • Stretching/mild exercise
  • Massage
  • Soak in bath/steam in shower
  • Sleep/rest
  • Soothing music (classical music has been proven to have a positive effect on brain chemistry!)
  • Only watch positive or funny shows/movies
  • Loving support from friends and family
  • Don’t drink alcohol or caffeine
  • *Nicotine may actually help (boosts “happy” brain chemicals that are low, which is the cause of Akathisia)
  • Fresh air
  • Sunshine
  • Laughter
  • Positive thinking/healing visualizations
  • Meditation
  • Eat healthy, fresh foods rather than prepackaged, processed, fast foods
  • Keep in mind it’s going to go away/ it’s only a transient condition
  • Progesterone (Yam) cream (For females) as recommended on box [Can get it at nutrition store]

*I would NEVER normally advocate smoking, but if you’re in total crisis with the anxiety/panic/terror part of Akathisia then I absolutely do advocate giving nicotine gum or smoking a try. Just be responsible and wean yourself slowly back off of it as you start feeling better. You will know right away if it’s helping or not.

Cyndi posted a request that I also include here the importance of letting others know about your allergies. I totally agree. I keep a sheet of paper in my purse at all times with the names of drugs I’ve had an allergic reaction to in the past, but I too think I’ll go make a laminated card for my wallet. It’s also a good idea to inform your family doctor and any other doctors you may see on a regular basis, as well as, the local hospital. Ask all of them to note your record for allergies. Especially the drug that induced Akathisia!

You may also want to make up a living will, which basically states what exactly you want done with your health care should you be unconscious. It’s important for each of us to be proactive in helping ourselves receive the best possible health care when needed, especially when you have special needs such as avoiding drug allergies.

Please take the time to read the comments that follow this blog, it can be very helpful to hear what other people have been through and how things are playing out for them. I want this to be a place where everyone can talk openly and share info, so feel free to share your current or past experiences.

I wish you a speedy recovery!

PS – I was talking with a doctor the other day about Akathisia and he recommended talking to a neuropsychiatrist. So, for any of you out there who are going through Akathisia, you may consider starting THERE instead of with folks who seem to be clueless to how it works, as so many doctors seem to be. From what I know, psychiatrists of all the physicians are most well-versed in how meds work and so a neuro – psychiatrist understands the neurological effects of meds. Interestingly, as I was looking up neuropsychiatrist I found that the man who coined the phrase Akathisia was indeed a neuropsychiatrist. Here’s the link to some good info, including that tidbit – http://www.answers.com/topic/akathisia

If you have any questions send a comment and I’ll get back to you.

Please read the following post! If you can’t easily locate it, here’s the URL to the same article –

http://www.antidepressantsfacts.com/reaction.htm

229 thoughts on “Akathisia INFO

  1. OMG I am SO relieved to find you. I have had a migraine for 3 months. I was admitted to the ER a month ago and given an IV of reglan. I had a total and complete freak out, panic attack my legs wouldnt stop twitching, moving, I was one second away from ripping my IV out, I just wanted out, out, out of there. The staff were so unkind, I had trauma on my arm they were ungentle with pulling the IV out. I went home and just paced and paced it took a week to begin feeling anywhere to normal again.

    I got a new doc, the migraine returned and he prescribed compazine, at first it felt relieving then these thoughts came in that slowly increased over the period of two weeks, I actually told my husband, “I think I will die before this is over.” I felt like I wanted to escape my own body, jittery, anxious, I was exhausted but couldnt lie down. I felt like I was losing my mind! Somehow I realized (I dont know how) that the meds were maybe the cause and started googling, came to learn that the ER experience wasnt me it was the Reglan! This whole time, on top of the trauma of the migraine and the constant pain I have been in, I have been further traumatized by the meds. I can only describe this as mind rape. 😦 I immediately stopped the compazine but headache returned. Is that the devil’s choice I have? To either live in constant pain or insanity? Reading your blog and your story and advice, I am SO grateful to you. I am just starting to piece together what has happened to me.

    Why didnt the ER or my doctor tell me? If I had at least known I could have partially controlled for the reactions rather than just freaking out. Why am I so reactive? Does this mean that naturally I have less dopamine in my system than other people, that I just dont have any extra to go around? Finally, are there other options that will work that wont make this happen? So far, no other migraine med (both western and non and I have tried just about everything including some real far left stuff) has worked.I have also had some antihistamines cause restless leg in me but on occassion. Otherwise I have never had anything like this happen and have never been on any kind of med for psychological reasons.

    Sorry, long comments here but finding you has been like finding a lighthouse… I’ve been in stormy seas for so long reading your story makes me so sad for you and for all of us but also so relieved that I am not losing my mind. Thank you for this.

    1. Jenna,
      You’re so welcome! I’m glad you found this info helpful. It IS maddening when you have no idea what’s going on and can’t figure if what you’re going through is your own mind or something externally causing it. I had the same issue at first, I had NO IDEA what was happening and had never heard of anything like akathisia.

      I don’t know enough about how the body works, but I would guess those of us who end up with akathisia have a more delicate system to balance.

      Now about the migraines. I too have suffered migraines for many years. But I finally learned about this woman, Donna Eden and all the great work she does. She has a video on youtube that instructs how to remove a headache and it works 9 times out of 10 even when I’m already at migraine status, it’s amazing!
      Don’t underestimate the power of natural healing methods and definitely give this a try!

      Feel free to share or vent when needed and send along an update and let me know how the headache maneuver worked for you : )
      All my best,
      Angie

    2. My sister gets akathisia from Reglan and my brother gets it so badly from Compazine that the one time they gave it to him, they had to inject enough valium to make him unconscious. It’s my understanding that for these two drugs at least, akathisia is actually not that rare a reaction. The trouble is that so many medical people just aren’t up to date with the literature. That’s one reason I mention it to every medical person Who treats me, including medical assistants, nurses, doctors, X-ray techs…if it comes up during care, I’ll use the term and define it if they have never heard it before.

      I’m so sorry for the ill treatment you and others have received. Medical people forget sometimes that the foremost expert on your body is YOU.

  2. I developed akathisia after taking Geodon for a year or so. The Geodon caused unwanted side-effects almost immediately. The most notable side-effect was something called extra-pyramidal syndrome (EPS). For me, it was essentially restless leg syndrome (RLS). My psychiatrist put me on 10mg Inderal twice a day and it went away, so he said it was EPS not RLS. After about a year, I told my psychiatrist about not being able to get to sleep because my head wouldn’t stop moving. He prescribed Trazodone. When that didn’t work, he prescribed a couple other things and I stuck with Vistaril (which is an anti-histamine, or basically prescription-strength Benadryl) for a while until my sleep specialist said that it could be contributing to my difficulty staying awake during the day and I conceded that it wasn’t doing anything for what I was calling “restless head.” That sleep doctor was soon after fired by me because he repeatedly said that my psychiatric medications could be why I’m tired all the time, but not once offered to call my psychiatrist and discuss it with him. My dose of Geodon went from around 80mg to 160mg during this time because my treatment-resistant depression was living up to its name. I started having problems with that psychiatrist’s schedule at this time. He was only in the office for 2 weeks, then out of the office for 2 weeks. On top of this, he took a 1 week vacation during one of his 2 weeks in the office (the week I was supposed to see him, of course). I also started seeing a new sleep doctor who was technically a neurologist claiming to be a “sleep disorders specialist.” She said I was tired all the time because I wasn’t sleeping well at night. That didn’t come across as news to me. She said she needed to speak with my psychiatrist before she could give me anything to help with the sleep. She was aware of the “restless head” which was also becoming “restless hands.” In the 8 weeks that I was technically under the sleep doctor/neurologist’s care, she attempted to call my psychiatrist twice and he never called back. From the time that I started explaining my “restless head” to my psychiatrist through the time I saw the neurologist, the word “akathisia” was not used. I decided to see a new psychiatrist because my original psychiatrist apparently didn’t have enough time to see me any more, nor did he care to return phone calls from another physician to coordinate my care or my phone calls saying “I’m sleeping so little that I’m having suicidal thoughts again.” (NOTE: I fall into a stereotype given to some psychiatric patients. If a doctor tells me me I have a problem, they just bring my attention to it and it makes it worse. The anxiety over a new insomnia diagnosis made my insomnia worse, partially because I fixated on it.) The day I saw the new psychiatrist, I was very upset. I was not sleeping well, in part because my head wouldn’t stop moving when I laid down, in part because I was very unhappy about being neglected by 2 doctors at the same time (in the sleep doctor/neurologist’s defense, she really couldn’t ethically do anything until she spoke to the psychiatrist). The new psychiatrist eventually called the sleep doctor/neurologist in front of me because I was so upset. He spoke directly to her, and she told him herself she was not a sleep specialist and had no idea what to do about my insomnia. In my opinion, every doctor should have an idea what to do about insomnia. For a doctor to claim to be a “sleep disorders specialist,” a doctor I had seen once and seen her nurse practitioner (who also claims to specialize in sleep disorders) once, and she said she has no idea what to do about insomnia? Now I’m sleep deprived, upset about being neglected, feeling cheated, and feeling like an idiot because I put a lot of faith (and a little bit of money) in this “sleep disorders specialist.” Let’s not ignore that this so-called “sleep disorders specialist” is technically a neurologist. Neurologists should have an idea of what to do about insomnia, right? And, in theory, she should have been the one to say something about “akathisia” being the reason I couldn’t stay still when I laid down and it was becoming impossible to keep my hands still if I tried. But no, it was the new psychiatrist who said “well, I guess an atypical antipsychotoic could cause akathisia. It IS more common in first generation antipsychotics, though.” That’s all he ever said about it. I’ve done the research from there. As for the sleep specialist/neurologist, I decided she wasn’t worth any more of my time and she decided to send me a letter saying she wasn’t going to see me any more. The psychiatrist gave me the option to decrease my Geodon dose and I took it. I initially went from 160mg of Geodon to 80mg in one go without telling my psychiatrist, but the withdrawal was horrible and I decided to go back to 160mg and do it a little more slowly with my doctor’s approval. In the last almost 4 months I have gone from taking 160mg of Geodon to 20mg, decreasing by 20mg at a time. The “restless head” has almost stopped. The “restless hands,” though…that’s another story. I’ll just say tonight’s a bad night, which is what led me to look for help again. I’ve developed carpal tunnel in both hands in part due to the repetitive nature of the “restlessness” in my hands. I have only been taking Inderal in the evening for the last several months because it interferes with my workouts, so I have plenty stocked up and took 20mg tonight. It’s still pretty bad. I honestly find that emotional agitation makes the hands a little more “restless.” I have previously tried up to 600mg of vitamin B6 (as recommended by Wikipedia), but it didn’t do anything for me, even after taking it at that dose for a week. You would think that purposeful use of my hands (like typing) would make them a little less “restless,” but not exactly. I drop a lot of things because my hands just HAVE to move, regardless of if I’m holding something. I will admit that, for the most part, the repetitive motions in my hands have decreased somewhat with the decreased dose of Geodon, but it is still a very significant problem. I have found one trick, but it only works for my left hand. If I make a light fist or sit on my hand, it stays still for a little while. Besides the fact that it only works for my left hand, the problem is that I’m developing a “restless” left shoulder. I also have arthritis in my hands and maintaining even a light fist ends up being painful. The only thing that keeps me from quitting the Geodon all together is that I’m not in a good place with my depression right now. When I see the psychiatrist next I will tell him it’s time to do something new so that I can stop the Geodon. I’m also afraid of the withdrawal from the Geodon. Stepping down hasn’t been bad, but I forgot to take my dose one night at 40mg and went into withdrawal until I realized I had forgotten and taken my dose 4 hours late. That’s how powerful Geodon is. Another issue I have with Geodon: you HAVE to eat with it. A meal replacement shake is not sufficient. The smallest meal I’ve gotten away with is a cup of Greek yogurt (regular yogurt is not thick enough). What happens if you don’t eat enough with it? It eats you and you throw it (and the rest of your psych meds) up. If you don’t take it? Don’t plan on sleeping again until you do take it. I’ll get mostly asleep, then all of the sudden something in my body jumps. The closest thing I have found to describe it is “exploding head syndrome” (look it up…it’s real). That gives you some idea as to why I’m afraid to stop taking my paltry 20mg dose. And there’s the whole “akathisia could be permanent” thing…That scares the crap out of me. I have mentioned my “restless hands” to a couple of people, and they said “I noticed,” so it’s not like they’re small motions that are easily ignored. My psychiatrist has offered nothing to help me aside from decreasing my dose of Geodon. After getting the blessing from my current sleep doctor, he prescribed me a benzodiazepine (Prosom) to help me sleep, but it helps me sleep a little too much. I took the 2mg he prescribed and slept for 30 of the next 36 hours. He said I could cut it in half and just take 1mg, and that only knocked me out for 12 hours. So, I’m still seeking my solution for akathisia and hoping that it stops all together shortly after I stop taking the Geodon all together, which will be soon (but not soon enough).

    Sorry this has been so long. Nobody has cared enough to listen to the whole story at once. Either they were there for bits and pieces of it and didn’t need the recap, or like 99.9% of the world (and 98% of doctors) they just don’t care to listen to the ramblings of the mentally ill.

    1. Tina,

      Your story just breaks my heart. So many of us have been, or will be, victims of medical “professionals” at some point in life and it’s just plain scary.
      They really put you through it and I’m sorry to hear it. I too have heard that the first generation anti-psychotics are the most offensive, as far as side effects go.

      I would really consider reporting that first psychiatrist you saw to the AMA and possibly also NAMI (nami.org). The ways he was treating you and also being non-responsive actually goes against the level of care one is to uphold when working as a mental health professional. He could potentially lose his practice and it sounds like he should.

      From what you’ve shared it seems like you have Tardive Dyskinesia rather than Akathisia. Basically if you are mentally tormented with a great sense of inner HELL, darkness and extreme agitation, then it’s Akathisia. But if it’s basically motor movements without the mental torment, it’s TD. Now let me state again – I’m not a mental health professional, nor am I a doctor of any sort. This is just my opinion from what I have read and seen through the years.

      In either case, you deserve to find healing and freedom from your symptoms. But I’m not sure how different the protocol would be to find healing with TD, as I’ve not really talked with many people with it. My guess is that it would be the same? Detox and allow the brain to balance itself out. But I believe the issue for you is that you are in need of taking antipsychotics, is that correct? If so, then I guess you would want to find one that is not that first generation type and get something more mild and agreeable to your body/brain.

      The folks here are very supportive, so please feel free to share your story, vent or ask for support as needed.

      Thank you for sharing your story and I hope you find competent medical care and a resolution quickly!

      All my best,
      Angie

  3. Hi everyone, my name’s Rossy. I’m reading all of this, and I can’t believe this even exist. My husband found out about akathisia today. He’s been on a lot of these medications for years now, but lately his symptoms have been getting worse. We thought it was depression, anxiety, he couldn’t stand being home, he had to be walking around, he was restless. Until today, he read about this. He texted me and he said, I might have found the solution to my problem, and he explained to me what this was all about. It’s sad that doctors don’t warn their patients about what could happened when you’re on those mess. Thank you for the information and for opening our eyes!!

    1. You’re very welcome. Please read through the posts and replies, you can find a ton of info here.
      Feel free to ask questions, many folks here are very supportive and will freely share their own
      experiences with you. I’m so glad he knows what he’s dealing with now and can take the appropriate
      steps to begin the healing process.

      My thoughts are with you both.
      Best,
      Angie

  4. Hi everyone,
    I took Compazine through IV 10 months ago and had a horrible experience. Around the 5th month I finally started to feel better. I am doing really well lately and finally feel like I have my life back. I am going to be an aunt for the first time and it has been recommended to my sister by her obgyn and pediatrician that everyone who will be in contact with the baby receive the Tdap booster. I am terrified of getting anything that will cause my akathisia to come back and set me backwards. I am extremely wary of medicines and even vitamins now that I have gone through this experience. Has anyone gotten vaccines after their experience? I am leaning towards not getting it, but I don’t want to harm the baby since whooping cough is making a resurgence here in the South. Thank you.

    1. Molly,
      It’s GREAT to hear you’re recovered and feeling good! I hope someone can chime in on your question, I have no idea what they put in those shots.
      I too avoid medications and any unknown vitamins and herbs, for the same reason.

      I guess logically you have to weigh the likelihood that you will harm the baby by not getting this shot (not sure where you’d find that info) against the ramifications if the shot were to cause a reaction for you and what the likelihood of that is.

      To me, there’s NOTHING worth risking Akathisia for…but I have no idea if this booster shot contains any possibly offensive ingredients. So I’d say look further into it…

      Again, it’s wonderful to hear you found healing in a short amount of time! And congrats on being a new auntie : D

      All my best,
      Angie

  5. Hi, I need help. This is my story. I’ve been on 15 mg Cipralex (antidepressant) and 1 mg Fluanxol (antipsychotic) since September 2014. I stopped the Cipralex after a fast 20-day taper. I got a severe withdrawal reaction after 11 days, so I reinstated 5 mg after 3 days of withdrawal. I stabilized. In April I tried to cut the dose of the Fluanxol from 1 mg to 0.5 mg and got very sick. I experienced a deep internal feeling of terror, horror, dread and doom, like a death of the soul, accompanied by twitching and jerking of the muscles when trying to relax and fall asleep. I couldn’t sleep because of the twitching. I reinstated and that symptom went away after a few weeks. The best way that I can describe it is the sensation that my soul is in hell and being tortured. I stabilized and was stable on my meds for 6 months. However, on November 9 I stupidly took a barbiturate. The hell started on the 13th. It was slowly building up from the evening of the 12th. I feel like my soul is in hell being tortured. I don’t experience agitation or restlessness. I don’t pace or move around. I just feel tortured internally. I lie in bed in agony all day. The horror flows like lava through my veins and I can’t distract from it. I have great trouble sleeping. I also have severe twitching and jerking of the muscles of the body when I lie down and try to relax, my whole body jumps around. I think the barbiturate messed up badly my severely sensitized from withdrawal nervous system. My question is is this akathisia and what the hell do I do now? It’s been 11 days of hell…

    1. Alisa,
      It sounds like you threw yourself back into akathisia with the new med. Let me remind – I’m NOT a doctor or any form of healthcare practitioner and it’s best to get the help of a qualified medical practitioner when you are having issues with medications.

      Having said that, if it were a friend going through the same thing, I’d highly recommend mega-dosing of vitamin C to see if you can cut through this toxic overload reaction. There is lots of great info online about megadosing vit C and it has proven for many to be VERY helpful.

      Cleaning up your diet, drinking plenty of water and finding ways to relax your CNS are key as well.
      Have you tried binaural beats? They can really soothe the brain in amazing ways and quickly.

      Make sure you get sunlight for a bit each day.

      Please view the other post here about suggestions for calming the body and mind.

      I believe because you know what’s going on so early this time, if you take proactive steps to get back into balance you could heal rapidly.

      All my best,
      Keep us posted with your progress and once you heal please share how you went about that.
      Angie

  6. Thank you so much for starting this website. My mom currently has akathisia from the countless medications she has been prescribed in this eight month long hell of a journey she has been through. If you name it, my mom was probably on it at some point. Her case is unique. She was completely normal eight months ago, and after unknowingly ingesting a chocolate with THC, starting exhibiting suicidal behaviors and a constant depressive state. That was when the hospitalizations began–the endless cycle of 51/50 holds, 52/50 holds, discharges from the hospitals only to be admitted again the same day, and there is still no end in sight.

    Please see her youtube channel to view videos of my mom and read about what she has been through. https://www.youtube.com/channel/UCTw-YAWn-R5y2SyObKYjvQg

    At this point, I am slowly tapering her off of her medications. The last time we tried to do this, her behaviors became erratic and life threatening so she had to be hospitalized again. Hopefully this time will be different. If anyone has further information on what we can do to help my mom, please let me know.

    1. Kathy,

      I’m so sorry to hear what your mother has been through. Someone’s idea of a good time, or a joke ended up with tragic results.

      Have you read the post where I give suggestions one by one for calming the brain and CNS? I’d start with basic things as I have listed there.
      I actually need to update that page, so I’ll go do that now so you have all the best info to guide you. Don’t underestimate the power of
      natural remedies and activities, such as large doses of vitamin C for detox and binaural beats for getting the brain back into balance…

      Keep us posted with her progress. In time she will heal, but I know it won’t feel soon enough for you or her, however, you just keep
      reassuring her and loving her. You’re her angel right now as you support her through this : )

      All my best,
      Angie

    2. I have been monitoring this website for a few years now, & I just wanted to give a shout-out & heart-felt “Thank You!” to Angie, the list-owner, for being so vigilant & supportive of people who are going through this horribly painful experience, in all its guises & experiences. I know it hasn’t always been an easy road for her, & I think we all owe her a huge debt of gratitude for her efforts to help a great many strangers escape the misery she has gone through. Thank you, Angie! Your kindness & support is a Light in the storm, & many of us are incredibly thankful for the effort you put forth. Bless you!

    3. Thank you so much Serenity. I do it because I see no other way. I have to. Thank you for the words of support and appreciation. You touched my heart 🙂

    4. Hello,
      I’m writing cause I had to go the “tapper off” option with my wife. She originally went to the doc for pain (MS) and he told her this will help you with pain(antidepressant). well she first started sleeping alot and still complaining of pain plus some and physical problems . Then she was starting to get up and do things ,but after awhile she started to be confused and frustrated ,which caused her to forget when she took her meds and ended her up at the center where they put her on an Antidepressant and an Anti psychotic. The first time I went to go see her I knew they did something bad to her ( face twitching ,big bruises where they gave her something in her arms ,not acting like herself ,scared ,men and women together in there and some only had a small gown( she was naked underneath) I could go on but what made me real mad is she had cloths before she went there and was in worse condition after being there.
      When she got home finally(3 weeks later) she couldn’t stop moving, had to walk around all the time or swing. She also was confused, scared ,and she didn’t know what to do with herself. She then started the uncontrollable movements , pounding her fist on her knees , kicking the legs, scratching her face , eyes would open during sleep and they were rolled back , she started hitting me. The list goes on. But I never saw the tongue thing happen
      The psychiatrist told her she would lower her dose but she lied. Then she sent a letter saying she was no longer going to be her psychiatrist. The first time she seen her she told her ‘ You’re just going to quit and end up back at the center. I knew then she wasn’t going to help her.
      When I looked up on how to wean her off , advice was to wean down half way on the antidepressant then start the wean process on the antipsychotic. this work well but still had to deal with the withdrawal , smoking alot of marijuana helped but sometimes triggered the symptoms for a few minuets but then calmed her down ,most of the time it did not trigger them.
      After she finally was off the antipsychotic she stopped the hitting knees and all but has the extreme back pain and an “episode” once a day that is usually short(alot of smoking weed still helps her) , even seen the eyes thing happen a couple times. being on her side and caressing her back seems to help . giving her a kiss or touching her lips helped stop the uncontrollable movement when it happened and most of the time it worked. massaging the legs arms and hands helps.
      On the first day off the continuous uncontrollable stopped and the back pain began. She slept for about 5hrs. the first few nights and on the 4th night she slept 6hrs.. The 5th day she was complaining so much of the back pain so I got her some benadryl ( recommended ),she slept 3hrs. woke up and wanted more but I had to make her wait of course. she didn’t eat the first day but had some chicken noodle soup the second day ,the third day she ate some chicken noodle in the day and chicken and rice at night ,forth and 5th day some food and alot of water/juice . That’s where were at right now and hopefully the pain will stop for her soon.
      Hope this helps you and anyone looking for solutions to these poisons they call medicine but can’t scientifically prove works. Guess that is why the say this “may” help or they “believe” it helps.
      Good luck to you all !
      Meds we use : Tylenol ,ibuprofen , melatonin + L-theanine , restful legs , Benadryl.
      Juices : Water , cranberry grape, orange juice , cranberry apple , chicken broth.

  7. My akathisia has. Come back with a vengeance. I was put back on clonazepam. I t helps at night. On propanalol and low dose of trileptal. Has anyone heard of zyprexa helping. Thought I read on one of blogs. I just had surgery for breast cancer. Maybe anxiety is making it act up. I got akathisia coming off clonazepam last year. This blog has been so helpful.

    1. Inez,

      I’m afraid going back on the offending drug is what set it off again 😦 I’m guessing it’s either that or the cocktail they give when putting you under for surgery. Either way, I don’t know if adding more meds will be helpful. I believe what will be most helpful is to follow the protocol you followed when you healed initially.

      Keep us posted.
      All my best,
      Angie

  8. hi,
    i have agoraphobia, and i have very low vitamin D levels and i took vitamin D supplements and i felt very irritated and angry, so i stopped taking them.
    i have developed OCD and my doctor tells me to take antidepressant and i am very scared of akathisia because i am very sensitive to meds.
    i cannot even take cafffiene, it makes me so angry and so i am very scared to take meds, supplements, vitamins.
    so what do u suggest???

    1. I find Nature to be the best remedy for anxiety and depression. Sunshine also helps your body make Vit D. If there is any way you can get into a safe, natural space and connect with the life force there, do it. Even it it is just a sunny window sill where you can plant some seeds and watch them grow!

  9. I came across this site and is wondering if this might be happening to me. I recently discontinued AD after 12 years of use. I did great for a month and then my anxiety returned full force. I decided to go back on AD and have been on for approximately 2 weeks. Since then the anxiety seems worse and I feel like I’m crawling out of my skin and am extremely restless. Do I continue on med and hope symptoms disapate once med is working again- if in fact akasthisia is from withdrawal or stop medication. Any advice would be appreciated. I don’t know if it is the anxiety or akathisia. Thanks.

    1. Hi Megan,

      I’m sorry to hear what you’re going through, but it’s GOOD that you are figuring things out early if indeed you’re suffering withdrawal related Akathisia.
      I’m not a doctor and so can’t give medical advice. But if you are EXTREMELY restless and feel like you want to jump out of your skin and it won’t relent, you’re probably dealing with Akathisia.

      From what I’ve seen, getting off the offending meds is the quickest way to resolve the issue, but again, I can’t give you that advice. Nor do I believe going cold turkey off psych meds is a good idea. Propranolol has been a lifesaver for many. If you catch Akathisia early and then get on a low dose of Propranolol it can make your healing path very quick.

      I’m not sure what AD is, but if you want to post another post and tell what exact med you’re taking, there may be others who have also had experience with that med and can give you information about how they are dealing with it, or have dealt with it in the past.

      Anxiety can be resolved in ways that don’t involve medication and the more natural approaches are always the safest bet. So don’t feel hopeless should you decide to titrate off the meds. You can still get back to a calm state even without the meds.

      Please keep us posted with what you decide to do and how things are going. It’s everyone’s stories being shared that help newcomers to the site and your willingness to share is very appreciated.

      There is lots of info on this site about ways to start clearing and calming the brain that can help you get back to homeostasis. Then if you should be back in the grips of anxiety, I and others on the board can help you through that. Anxiety can feel quite easy to deal with once you’ve been through Akathisia and I’m sure you will get a lot of great advice from everyone here.

      All my best,
      Angie

    2. Yes–Megan, what is AD? Quick onset makes me suspicious that it is withdrawal. An excellent book is The Antidepressant Solution by Joseph Glenmullen. He dedicates a few pages specifically to akathisia, and helps you determine whether symptoms are due to withdrawal or not.

    3. I discontinued Prozac. I did fine until week 4. At week 6 I reinstated Prozac hoping for some relief. It has been almost 2 weeks since I’ve been back on. My doc gave me Ativan to help with the anxiety and honestly I feel it almost makes it worse. When I take the Ativan I feel like crawling out of my skin or maybe it’s just the anxiety, hard to tell. My anxiety is worst into the morning and I start to relax around 6 pm. I am currently sleeping. Just praying the Prozac will kick in and work like before. Am really suffering.

  10. I am afraid that I may actually have sporadic fatal insomnia instead of akathisia. I stay awake for 40 hours then only sleep for 4. I’m having internal tremors in my chest head and legs which are all symptoms. I can’t eat or take care of my daughter. My balance is off. When I try to fall asleep my eyes jerk right back open like lightening. think I am going to die.

    1. Sarah, you need to get in to see a neurologist asap. Let them give you a full proper evaluation. The only thing I can tell you is that everything you’re talking about, even this level of insomnia is very very common to Akathisia. Many of us who have been through it also thought we would die, but didn’t. It’s amazing what the body and mind can tolerate and bounce back from. Have you viewed the other pages here? Are you following any of the recommended protocol?

  11. I’m so glad and thankful I came across your blog.

    Weaning off of Paxil has become basically a full-time job for me the past 2 months (feels like 14 years!), and the worst and scariest of the withdrawal symptoms is the akathisia.

    The good things:
    -I’m grateful for this blog, as I just woke up from a sound sleep in a rage b/c of the akathisia and this blog is wonderful.

    –Fought w/my psychiatrist (I ended up in tears) for an Rx for LIQUID Paxil (expensive but only safe way for me to continue weaning more slowly.)

    I’d like to share the following w/fellow akathisiasts:

    -Be safe and do not take this akathisia lightly. In his book The Antidepressant Solution, Dr. Glenmullen talks about SSRI withdrawal and points out how akathisia/agitation combined with decreased inhibition can be very dangerous. There are crisis lines to call; even suicide prevention apps you can get for free, to have a safe plan handy on your smartphone.

    – I also want to share with others how helpful acupuncture has been for me. On a day when nothing, nothing, nothing else works (tai chi, plenty of sleep; weights workout; fish oil; magnesium; no sugar; plenty of protein; healthy fats; veggies), I go into acupuncture and am absolutely guaranteed at least an hour of calm. Acupuncture doesn’t hurt, and doesn’t have to be expensive. Google “community acupuncture” and you may find a clinic near you that offers treatments for as little as $15.

    I look forward to the day when I look back and this akathisia is just a memory. I wish us all the best!

    1. Sarah,
      One thing,, I’ve heard of fish oil making Akathisia worse, so please be thoughtful when using it and pay attention to be sure it’s not causing more harm than good.
      Keep us posted with your progress. You WILL work your way through and out of this!
      My thoughts are with you,
      Angie

  12. I have been suffering from akathisia for 24 days, and I am at the end of my rope. I am prescribed Klonopin and Propranolol which help some. I want to start tapering off of the Klonopin as I don’t want to become addicted. I’m also concerned that using Propranolol, while helpful, will only prolong the healing process. If anyone on here has used Propranolol to recover, did the akathisia return after stopping the Propranolol?

    1. Hi Sarah,
      I’m very sorry to hear what you’ve been going through. The good thing is that you got Propranolol early on, this may be all the difference between having a long recovery and a shorter one. Those who I’ve seen get Propranolol early on tend to recover much more quickly.

      Hopefully someone can answer your question..But from what I know, you will taper from that as well, once you’re feeling back to your old self. There should be no issues afterward.

      All my best,
      Angie

    2. Sarah, I hope you feel much better soon! I have been where you are, and I know it is a rough road.

      As for the Propranolol, which version was prescribed for you: is it regular, or long-acting? It may be called, “Inderal LA” for “Long-Acting” or Time-Released. The reason why I ask is, I found out after my doctor prescribed the LA for me, that for akathisia we need the NON-long acting version of Propranolol in order for it to work better for this condition. Please find your medication & make sure it is the most helpful one, if you still need it. Luckily my doctor didn’t have a problem with it when I asked him to switch me to the regular version, rather than the long-acting one. I was prescribed 40 mg of Propranolol and that worked much better for me than the long-acting version.

      As for if you will have a problem stopping that med eventually…I now make it a rule to wean slowly off any med, rather than stopping anything suddenly. It is hard to realize that with akathisia avoidance, it is just as important to wean slowly off a med, as it is to be careful about which meds one takes. There are some that it doesn’t matter with, but it is just easier for me to make it a rule to do that for each one, if I can. That way, I don’t make a mistake I’ll regret later.

      I have weaned off of Propranolol before, without any problems with akathisa. But someone else might have an issue with it; that’s just me. I know that Klonopin is more addicting for the body, the longer you take it. But when you go off of it, I would consider weaning off of it over a much longer time than you normally would. I would first cut the dose by half, then 1/4. I would do half a dose for maybe 2 weeks or so, then 1/4 for another 2 weeks, maybe even longer. I have learned that with myself, my body seems to adapt easier if I give it more time. The one I cannot seem to stop is the Ropinerole. I am down to 1/4 dose now, but if I don’t take it I will get those awful restless legs & can’t sleep. I get so weary, I end up taking the 1/4 pill. I want off of it, this is like a double-edged sword.

      Another factor for everyone on Propranolol to consider: it also lowers blood pressure, so it is a good idea to monitor your b/p while you are on it (to see what your body has become used to), and then while you are weaning off of it. I noticed that if I tried to wean off of it too much or suddenly, it would cause my b/p to skyrocket. Luckily, I got a headache & it occured to me that it might be my b/p since I had recently weaned off the med, so I checked it & sure enough, my b/p was dangerously elevated. So, be aware of your norms, since that could potentially cause a problem. Doctors rarely think to mention that to people when going off some meds, for some reason.

      I hesitated to mention some of these issues because I don’t want to scare you, but it is a reality we have to face when we take meds, & I think it is more important to give you a heads-up, rather than allow something preventable to happen. Still, I hope this email didn’t frighten you. Meds are necessary sometimes, but we can take safety measures & deal with those risks in a way that makes it ok to get the help we need.

      I wish a quick & full recovery for you.
      -Cyndi

  13. I was put on zanax and kolonopin as well as 3 differnent ssris (not all at the same time) in 3 months time. Since then i have dealt with intrusiive thoughts and harm thoughts. Scares me so bad. Methylated b made it qorse. I have taken fish oil as well as vit d to help with no avail. On top of that i am taking biodentical progesterone. Nothing works any suggestions????

    1. Robin,
      I’m sorry for all you’ve been put through will all these meds. The good news is, it doesn’t sound to me like you are dealing with Akathisia. That’s good news because, Akathisia is a difficult road. But that doesn’t at all negate the pain you are going through. Intrusive thoughts are scary, but can be quite common with just basic anxiety and/or depression, so don’t let the worry about this take you off center. And the thing with intrusive thoughts is, when one pops up, you tend to get hyper focused on it and then the what-if’s start and then before you know it, you have worked yourself into a dither. Just keep in mind that you really do have control over our own thinking. Be okay with the thoughts, let them come and then go. Just because they pop into your head doesn’t mean in any way that you want to or will act on them. I have to say, I’m not a doctor or a therapist, so I can’t make mental health or medical recommendations..all I can do is share what I’ve learned, been through, or seen others go through. If you feel you need professional help, or if you feel you’re a threat to yourself or anyone else, then seek the help of a professional.

      Lastly, I’ve personally experienced Vit D as a cause for anxiety/panic attacks. I’ve also known others who have been affected this way by it. So be careful even with vitamins and herbs if you’re not sure how they might affect you.

      And, fish oil can cause mental side effects as well, it’s something else I’ve seen others deal with and have read a bit about it. Any substance that can improve mental/emotional well being can also cause issues, if it’s not something your body/mind needs, or wants at the time.

      So just use supplements and such with caution, do a bit of research before using new products and don’t let scary symptoms cause you to doubt your own sanity. Everyone gets freaky thoughts from time to time, but it’s those of us who tend to be more anxious types who then get all wrapped up in worry, rather than just letting the thoughts flow on by. So just understand your biggest enemy with all of this is your hyper-vigilance and unwillingness to just accept what is. So try to just go with the flow and be easy on yourself : ) The less importance you put on these thoughts, the sooner they’ll stop coming to mind..

      All my best,
      Angie

    2. Well since i have been off of benzos since february, i have seen a phychiatrist and he thinks counseling would have helped. I started trying high amounts of fish oil and also methylated b vitamins. I soon realized the b vitamins made me have fits of rage like bipolar or something. I am also taking just started, progesterone, biodentical hormones. I am so lost. I have tried almost all the natural ways to heal my brain along with 5 htp which made me angry and cry and there has been no relief. I have fear being put on more meds as this is what got me where i am!!

    3. Robin,
      Often times throwing a bunch of new chemicals into the equation does just make things worse. It might be better to hold back on experimenting with stuff. I’ve heard a lot of bad about 5-HTP, even though for some it’s a miracle. Some people have trouble with fish oil as well. I wonder if yam cream would be a safer way to introduce your body to progesterone, rather than going straight to pharmaceutical strength? I tried progesterone bio at one point because the doctor said I needed it, but it put me into rages and anxiety. When I had akathisia, I used the yam cream with much success though.

      So I’d just say, go easy on your body and when you try new things, try ONE AT A TIME. This way you can be sure what is affecting you and how.

      I’ve never heard of B’s causing agitation and they tend to be very helpful for anxiety/agitation, etc. So you might want to revisit trying B’s or at least
      B-6 once you are at a place where you really aren’t trying a whole bunch of stuff at the same time.

      You can get through all this and recover, but I really do believe you have to take one step at a time and go slowly. Take the time to let your body
      detox from all it’s had thrown at it and then methodically try things you have researched and really feel in your gut will be useful.

      Don’t let the doctors just bully you around and throw things at you. They’re really just all about sticking pills down patient’s throats. So be your own best advocate and researcher. Your intuition can tell you a lot if you just slow down and take the time. I know you can feel frantically desperate for a “cure” when feeling so out of sorts, but going slow will probably be your best ally.

      All my best,
      Angie

    4. Robin, from my experience with this illness my advise would be to try and wean off everything that is not helping for as long as you can. It’s harder to actually be taking meds that make you worse than tying to cope with the symptoms. It’s a nightmare I know.

  14. 1 half dose of the fluoxetine caused sleepiness and some cramping so that was stopped. The GP has recommended another medication called Zoloft. Reviews on this med is that it is administered to children, pregnant women and women breastfeeding, so it appears to be gentle and have commenced today. We have also managed to secure an appointment with a private psychiatrist in a couple of weeks.
    I believe she is starting to show signs of recovery from the akathesia as yesterday the Valium was not putting her to sleep and today she was able to sleep without it. I went back to work and didn’t get any phone calls of distress. We are not at the point to say that it’s over but there is signs of improvement. We are at the 3 week mark and the original psychologist said it would only last a couple of days.
    Maybe they need to be introduced to Dr Google to widen their knowledge on this subject.
    Thank you for reading this and letting me vent the frustration.

  15. I have been witnessing my wife go through what we have been told is aka thesis. For the past five years the diagnosis has been a mixture of depression, bi polar and even psychosis. Different medications over this time have all given side effects and little relief to the problem. Try respiradone and at last some relief for a couple of weeks before the “Professionals” decided increasing the dose would be better. Bad side affects and was advised to taper off slowly but stopped after a few days because the side affects persisted, changed to fluoxetine but this caused severe nausea and insomnia so then they said stop all medication. Hello akathesia week one restlessness, pacing and moments of delirium to the point of being admitted to hospital, treatment being Valium and an explanation this should go in a couple of days. Now in week three and doctors are trying to say now it is something else but whatever I read the symptoms are akathesia brought on by the discontinuation of the medication. I am over the doctors thinking they know all and saying it is my wife’s head. The doctors are saying that the short time on respiradone the symptoms should be gone, I am of the belief they are not considering the medications over the past five years.
    I feel for all who are witnessing a loved one go through this, I am looking for the light in the tunnel, not going back. Be patient with your patient, they need your support more than ever. Don’t expect it from the medical profession.

    1. Robert,

      I’m so sorry for what your wife has been going through. It amazes me how these doctors play mad scientist with people’s brains. These meds are all “new” in the grand scheme of things and they really don’t understand what they’re messing with. I’m glad she’s off of everything, but yes, now is the trek back to health. Please refer to all the suggestions on this site. I’ve listed many things I know to be effective and others have posted helpful info as well.
      Please feel free to ask any further questions and keep us posted with her progress.

      You are truly one of the rare gems who is sticking by their partner’s side. Many husbands seem to get too overwhelmed and either abandon their partner emotionally or get accusatory and angry and simply won’t take the time to understand and help. Thank you for sticking in and doing all you can to help her, it’s heart-warming to see.

      All my best,
      Angie

    2. Thank you for your encouraging words. Today she felt as though she couldn’t take it any more and took a half dose (10mg) of fluoxetine going against my advice to her. After about an hour there was some improvement and when the two hour mark came round the waves of emotion started. Took 2.5 mg of Valium which gave temporary relief before the emotional stuff happened again. A local pharmacist suggested it was okay to take this with the other. The psychologist that was dealing with the situation believes my wife is faking her emotions to get attention and has closed her case. I guess they have tried all their known options and are at a point that they can’t do any more. She now feels deserted by the so called professionals and wonders if she will ever have a normal life again.
      I will continue adding to this page with my wife’s progress in the hope someone will be encouraged that they do not suffer alone.

    3. Thank you for sharing, I agree, this will be helpful for others to hear about someone else’s journey.

    4. Hi Robert,

      It has been my experience with more than a few doctors that, after they try a few treatments on us that we don’t respond to favorably, they would rather blame ‘us’ for somehow not being reasonable or cooperating, and try to make it our fault. I suppose it vindicates themselves in their own minds from needing to do more when they are actually clueless & unmotivated to go the extra mile that it takes to help patients that need more in-depth care than the instant fixes that throwing a script at them can bring. After all, that’s a pretty lucrative gig to see dozens of patients each day, charging huge fees for a 15″ appointment each, & rushing us through their work-days like a herd of cattle. If we take up more of their time than is allotted to us, we are cutting into their profit margin, & the lesser physicians get annoyed at that intrusion. That is a huge failure on their part, and a challenge for us to not doubt ourselves or our suffering loved one who is going through this ordeal. This is when we have to refuse to accept less than excellent treatment from our physicians, and may need start shopping around to find one who truly cares.

      I’ve searched far & wide on the internet for helpful info on akathisia, and this site run by Angie is the most helpful I’ve found. What helped me with getting over the initial akatisia, was propranolol NON-extended release tablets–the extended release did not work for me with akathisia symptoms, and I found out from others that it is the NON-extended release tablets that work for these symptoms. Doctors frequently order the extended variety, so be alert to that if this is prescribed for your wife at any point. The other med prescribed for me is ropinerole, which I don’t like taking & have been very slowly decreasing. I am about ready to wean off that completely, but I admit I’m dreading the symptoms worsening until my body adjusts.

      Angie & others give good advice about how to find a knowledgeable physician that knows how to treat akathisia, and doesn’t prescribe the very drugs that will only cause more problems. I no longer take a prescribed med without researching it thoroughly first. Detoxing the body after it has been negatively affected by the chemical soup of meds can take a while but is very important to work on accomplishing. A magnesium drink mix named CALM helps greatly, which you can find on amazon & read the customer reviews to get an idea of whether it is something you wish to try.

      If you don’t want doctors to prescribe medications that you know cause an allergic response in your wife, remember to tell them she is allergic to those meds, and every other doctor you see from that point on, so they aren’t prescribed again. They pay attention to the word “Allergy” moreso, because liability enters into the equation at that point. If you just say you don’t like that med, your wishes could be ignored. This is something for your wife & you to work out together & decide which ones are the problem. Remember to look up the types of meds that can have similar reactions. For example, I know I have a reaction to Compazine, so I say I am allergic to Reglan, also.

      I found that keeping off caffeine helps the body detox, and lessens symptoms. Any stimulant seems to ramp up the symptom misery, at least in myself. The vitamin C remedy is very helpful to follow, with lots of water to help the body cleanse itself of all those chemicals.

      I hope your wife finds relief soon, and that you both will be able to get back to your lives & put this behind you.

      Cyndi

    5. Robert, your wife is fortunate to have you with such support and love. Is she doing any better now?

    6. My wife is past the akathesia, unfortunately this led into aggrevated depression, this is being treated and she is doing much better. Still a ways to go yet but much much better than a couple of months ago.

    7. Thank you for the info Robert. I’m sorry she’s still suffering, but it’s good to hear she’s improved so much.
      It’s just a matter of time before she’s free and clear. Healing definitely happens in steps..it certainly sounds like she’s
      getting there.

  16. Hi,
    My heart goes out to everyone on this forum. I’ve only dealt with akathisia the last couple days, and it’s truly maddening. Thank you for the article with the tips and all your positivity. It truly helps. After suffering a panic attack and going to the ER, a physician who clearly didn’t know what they were doing prescribe my haloperidol. Foolishly without doing much research I took it- later realizing it’s an antipsychotic and far beyond what I needed. I took about 8mg which is a lot. At first it just made me feel good and knocked me out. It was about 30+ hours ago when I took it. The feelings of weakness, restlessness, needing to constantly move, and feeling foggy and irritable worried me and I went back to the ER. They were compassionate but not much help. They gave me a shot of Ativan which definitely calmed things down for me, but it is not gone. I’m going on 2 days of feeling like this, which I know is nothing compared to what some are dealing with, but I’m curious as to how long this will go away or be out of my system? Of course no one can know for sure- but does anyone know typically what’s the longest someone may have these symptoms when only having had ONE dose of haloperidol? (Albeit a large dose I wasn’t on it any extended period of time.) It’s difficult not to worry that I did some kind of permanent damage, so some reassurance would be helpful. 😦 I have been treating with B vitamins, Vitamin C, Benadryl, and Xanax. Is there anything else particular to the restlessness I should look into? And how long should I continue taking the things that I am to help this? When symptoms cease or beyond? The Xanax and Benadryl make me a little sleepy during the day, but I would rather feel tired than like this… Blessings to all.

    1. Chelsea,
      I’m very sorry you are going through this. There is no way to know, you’re right. BUT, I’ve heard that mega doses of Vitamin C if taken very soon after insult, can detox the offending drugs out of your system. I don’t know if you’re dealing with the drug still, or the imbalance it’s caused your brain. I don’t want to waste time yammering on, let me end now and just HIGHLY suggest you consider mega dosing with a powder (mix with water/juice) form of
      Vitamin C….
      Please let us know how you’re doing, or feel free to follow up with any further questions.
      And if anyone has experience with this particular drug,, please share your experience or understanding.
      All my best,
      Angie

    2. Chelsea, I don’t think that it was “foolish” to take medicine that a physician prescribed you. 🙂 We should be able to trust doctors completely.

  17. Hi

    I was taking venlaflaxine then prozac 10mg for 16 years I stopped last July 2014 cold turkey and felt fine for a month or so then he’ll let loose. I was very ill with what I know to be akathesia it peaked in December, January and February when I experienced a fear that words cannot describe. I came very close to suicide as I could not stand to be alive with those feelings one more second. Even though currently I can sit for longer periods of time there is no peace in it and it still feels wrong to sit, my legs and arms tingle constantly. I also suffer many other symptoms and have gone from running marathons to 10 minute walks twice a day on good days.

    You have no voice when you have had depression prior to taking antidepressants, even though my depression was mild and did not limit my life too much this illness has made it much worse. Who would not feel depressed though if you had lost your job, your health and your marriage was seriously suffering. Doctors dismiss everything I say when you are viably distressed they look only at your long use of antidepressant and say you obviously need them to be well. I even had one doctor smirk in my face when I suggested ssris cause akathesia. Can you imagine how that feels when you are living in hell everyday.

    It has been nearly a year since stopping ssris cold turkey which I know was a huge mistake. My real question is do I keep swimming for shore or go back to them to see if they relieve my symptoms? If I knew I would get relief in another year I would hang in and wait it out I’m a very strong person but this has destroyed me physically and mentally.
    Thanks

    1. Catherine,
      I’m so very sorry to hear what you’re going through. Of course no one can make that decision for you, you know in your heart what will be best for you.
      All I can say is from what I’ve seen, and generally going back on the offending meds does prolong the healing process, big picture. But if you get to a point where you can’t take anymore, then doing whatever it takes to just get a shred of relief is clearly the answer.

      If you feel okay to keep fighting without the meds I would HIGHLY suggest you follow as many of the suggestions I’ve given on this site as you can. Every little bit helps and yes simple natural remedies can make a BIG difference. I would be sure to get on the yam cream, asap and take it as directed. You can get it at any nutrition store, probably Whole Foods if you live near one and I have ordered it from Amazon in the past, so I know it’s available there too. But that’s just one thing I know can make a big difference, please refer to all the info I’ve provided on working through the healing path of akathisia.

      Mega doses of vitamin C can be very healing and help with deep cellular detox. The B vitamins are very important for mental/emotional balance. And getting your mind habitually in the most positive thought patterns possible is essential.

      But again, please read through all the suggestions and follow what feels right to you.

      Keep us posted with how you’re doing and feel free to write again with any further questions.
      All my best,
      Angie

  18. I have been taking a high dose of Latuda for about 2 years with no problems until recently. Within a short period of time I have developed extreme tremors all throughout my body where holding a cup of coffee, texting and other fine motor skills are almost impossible. I went to a neurologist and he did an MRI which came back completely fine. I have many of these symptoms listed. I’m wondering if my tremors could be directly related to the Latuda. Tremors aren’t listed here as a symptom. My doctor is slowly weening me off of this medicine and has given me cogentin for the tremors which has not helped at all. She feels once the medicine is out of my system the tremors should stop. Latuda wasn’t listed here either but it is an antipsychotic. My main question is: are tremors also a symptom?

    1. Jennifer,

      I’m sorry to hear what you’ve been going through. The list here is certainly not all inclusive, so I’m sure there are many meds that can that aren’t listed here. Most particularly the antipsychotics. Through the years, I’ve heard of so many neurological symptoms associated with psych meds and akathisia, so I’m sure tremors is among those symptoms. Many suffer with all sorts of muscular symptoms, this is just yet another, unfortunately. I would think they should subside once you’re off the meds and your body gets back into balance. So even if you’ve completely stopped the medication and you’re still suffering with the symptom, don’t lose heart. It may take your body/brain a while to get back into complete balance.

      Keep us posted with your progress.
      All my best,
      Angie

  19. Has anyone come up with an emergency wallet card to have on-hand, to protect us in case of an emergency? I want to order one that lists all the medications that I shouldn’t be given. I wonder if anyone has worded one already, so I can use it as a template. Thanks in advance.

  20. i am an asthmatic. all types of cortico-steriods such as dexamethasone, prednisone, hrdrocortisone , betamethasone, triamcilone has caused akathisia on me. please include the above drugs on your above list.

    1. I am prone to chronic akathisia, after having come down with chicken pox that caused meningo-encephalitis. In fact, my neurologist told me I would always have to guard against this worsening to Tardive Diskinesia, which is very frightening for me to realize. Anyway, I also have had an akathisia reaction to using a prescribed albuteral inhaler. It is like having to choose between one of 2 evils, or choose which symptoms I can bear with less agony. My heart goes out to anyone having to endure such a condition. People who haven’t experienced this cannot begin to understand how terrible it is. Once you have experienced it, you never forget.

      I now watch every single thing that I consume, be it beverages, food or medications/supplements of all types. I am most challenged trying to find a beverage I can enjoy besides water, which won’t trigger symptoms of muscle cramps in my legs & jitteriness. I stay away from caffeine, but even caffeine-free (I have since learned that decaff doesn’t mean zero caff) and no added colorants or dyes will still cause this reaction. I don’t understand it, but for me on this one issue, I think it could be tied in to a lack of nutrients or enzymes in my body, and plan to get tested soon. Magnesium, calcium, iron & potassium levels, especially. I do have issues with malabsorption, so maybe there is a link for me within that area. I can’t change whatever neurological changes took place after getting ill, but I can hopefully find out what are specific triggers and how to avoid them. I wanted to post this in the hopes that others may be alerted to a similar tendency, so they can start evaluating their own triggers more closely, and hopefully learn to avoid them. I am quite surprised how many things will trigger it in me, now: tea, soft drinks of all types, coffee, -including any decaf or caffeine-free versions. I have read that even tea or coffee that is touted as caffeine-free will still have it, because these products always contain it naturally. Labeling can get away with this because of the reduction levels, but I think this is very misleading. So, if you are sensitive to caffeine & still having reactions as I am, please consider researching your product and figure out if what you thought was caffeine-free may in fact be the culprit.

      Good luck, everyone.
      SerenityNow

    2. Serenity,

      I’m sorry for all you’ve been through. Thank you for sharing this info with the board.

      I’d recommend, and should have already posted it, transdermal magnesium. I found after starting to use it fairly regularly that I am clearly
      low on magnesium. I feel quite different after using it. The transdermal seems to work much better than oral supplements. I’d bet most who are
      prone to anxiety or imbalances such as akathisia also have a need for magnesium.

      Also, there are herbal teas which are naturally caffeine free. I agree about checking all labels and being an aware consumer. Generally, if it says decaffeinated, then it does have some level in there, as it’s simply gone through a decaffeinating process. But many herbal teas are naturally caffeine free to start with, it’s just a matter of figuring out what’s what.

      All my best,
      Angie

    3. Thank you, Angie. The transdermal magnesium you mentioned–is it OTC, or do I need to try to convince my rather blase’ doctor to order it for me?

    4. I have to put the disclaimer that I’m not a physician, nor can I act as one in any way. I’m merely suggesting something that I have found works well for myself and some people I know. If you have any health issues or concerns about using any products I have suggested, please consult a professional health care worker.

      The one I use is Ancient Minerals and you can get it on Amazon, or wherever. You can get spray on or the thicker lotion one, but they’re all basically the same. I have to warn you, the more your body needs it, the more it burns/tingles while it’s on. The good news is, you only leave it on for 5-20 minutes.
      I find if I just can’t deal with the discomfort on a particular day, if I put it somewhere less sensitive, such as my feet or lower arms and hands, then it’s more tolerable. But you will notice a difference in the way you feel almost immediately and certainly within a few days of regular use.

      Let us know how it works for you! Feedback from those who are frequenting the board is the most helpful feedback for others going through this.

      All my best,
      Angie

    5. Thank you Angie, that is the brand I had picked out when I went searching on Amazon after you mentioned the type of product it is, so that is good to know. I have used CALM before & find it useful, but it can affect me witn gastric upset sometimes, so I am looking forward to trying this cream. I had previously ordered magnesium oil, but it is a bit messy and I would much prefer a lotion or cream. I really appreciate you sharing what you’ve found to work, and understand the disclaimer. Thanks again!

  21. You’re comprehensive information is truly ‘spot on’. I experienced profound akathisia after being administered both Compazine and Reglan (on separate occasions) to treat post-surgical/post-anesthetic nausea. Genetically, I cannot tolerate most forms of anesthesia (due to very mild porphyria) and end up terribly nauseous… so, as the saying goes, I’m between the devil and the deep. Also, I’ve had doctors act as though this could never occur when I report the symptoms…and here is the ironic part: I’m an M.D. myself and why would I be telling them something that wasn’t true? To the author of this article, you should have been a doctor yourself; honestly, we need caring people like you to counter the plethora of jerks who seem to gravitate to this profession.

    1. Thank you and thank you for giving your professional thoughts on Akathisia. This will be very comforting to my readers.

  22. I’m another one who has experienced the terrors of akathisia (still experiencing it today) and believe that in my case, excessive alcohol use as well as antidepressant usage/discontinuation both contributed in their own ways. I had been on prozac (20mg) for OCD for the best part of 10 years. Around 3 years ago I started experiencing a return of my intrusive thoughts and felt generally more agitated – I was drinking several beers each night, and while this was not excessive, I believe that this played a role in sowing the seeds of akathisia.

    I knew that prozac was activating, and so went to the GP to request a switch to another antidepressant. Went on citalopram for ten days, and bam – hit by horrendous intrusive thoughts. I stopped everything and soon the agitation magically disappeared. However, I was becoming more and more depressed by the day, and so asked my GP for a smaller dose – 10mg – of citalopram. I took this for 6 weeks (I was drinking ever increasing amounts of alcohol too) and my depression lifted – to be replaced by physical restlessness, agitation and intrusive thoughts. So I cold turkeyed the citalopram, felt better for 6 weeks…and then was hit by agitation, terror, panic, and intrusive thoughts again – but this was worse than at any previous point in time.

    Since then I have been off and on various meds – I managed to get semi-stable on fluoxetine again but tapered off because of sexual problems and irritability (the akathisia went away but I again fell into a deep depression) then I tried citalopram again, which worked at 5mg, but gave me visual snow and severe cognitive impairment…tried another couple of meds which brought back the akathisia…and now I’m back to my 20mg fluoxetine (with 160mg propranolol) and hoping I can stabilise on this before I can commence a slow taper – changing meds searching for a silver bullet has been futile.

    Today I can’t tolerate alcohol or caffeine and I’m hypersensitive to a lot of things – I believe however that my constant ‘chopping and changing’ has delayed the healing process – but hoping I can stabilise on the fluoxetine, which worked in the past. The physical restlessness, agitation and feeling of not being in control of my body is probably one of the most terrifying things I have ever faced though – and when it was at its worst I would have been prepared to take any medication if I knew that it could provide any kind of relief. I know now that my body’s reaction to alcohol was a warning sign – just wish I heeded it sooner…

    1. Pete,

      Thank you for sharing your story. The various accounts of people’s experiences helps newcomers in understanding their own situations better.
      Please keep us posted with how you’re doing.

      All my best,
      Angie

  23. Thank you for sharing your story. I chanced upon this blog while searching for an explanation for the awful, weird, anxious, restless feeling I get when I take certain antihistamines in the form of otc sleeping aids. I take the sleeping pill, then minutes later feel this overwhelming sense of panic and tension. I can’t stop moving my arms and legs. I clench my teeth and feel like I’m going to jump out of my skin. It’s horrible. Now, I know I have a legitimate physical reaction to the medicine. I’ve tried the otc sleeping meds several times, and every time I had the same reaction. I could barely stand it for one night, so I can’t imagine the hell you went through dealing with this for months! I never even knew it was “a thing” until it happened to me. People should definitely be made aware of this side effect. Again, thanks for sharing.

    1. Nichole,
      I’m really glad you found information that made sense of your reaction to some meds! I’ve become an even greater supporter of natural products, they’re definitely worth looking into. Check out Natural CALM powder for help with sleeping : )
      Angie

  24. Hi there, 4 weeks ago I started on a depot of flupentixol. I am only very small so they gave me the lowest dose possible, I had 2 injections, 1 every 2 weeks. Soon after the second injection I began to get akathisia and it is the single worst experience I’ve had in my life. The doctor took me off it and It has now been 2 weeks and 3 days since my last injection but my symptoms are not really showing any signs of improving. I am ABSOLUTELY TERRIFIED after reading so many posts here and there on the internet, from people saying they’ve had akathisia for years or even permanently. I’ve barely survived these 3 weeks let alone any longer.

    The doctor prescribed procyclidine for me which seems to give me some minimal relief but I am now scared that if I have to stop taking it I will get even worse akathisia due to withdrawal from the procyclidine as it is an anticholinergic medicine.

    I wish I knew this would end or when, please help me.

    1. I’m very sorry to hear about your situation. Akathisia IS terrifying. It’s miserable. But you WILL get through it. It’s just a matter of being patient. And I can tell you from personal experience you will feel every day as if you cannot go on one minute longer, but you can and you will. It’s hard to say what will happen when they take you off the procyclidine. From what I’ve seen, balance happens fastest when the body is on no drugs, so I wouldn’t worry about coming off, so long as it’s titrated down slowly.

      Please follow all the suggestions listed on this site. There are many ways to detox and soothe a frayed nervous system and brain hormone balance, which is basically what you’re dealing with. Start with having FULL FAITH that you will heal, but know it may take time and be kind to yourself and patient with the process. There are plenty of people here who can support you through this and if you need to talk privately just send another post and I’ll write you back personally.

      My thoughts are with you.

  25. I am from Ukraine, I drank Paxil 3 months. As finished, began akathisia. And the last 2 months, it’s unbearable, but lately it’s easier. (I can help Benadryl? It contains no alcohol will he do worse?) Know English bad sorry

  26. Hello,
    I would like to know your opinion….I was put on trazadone for sleeping problems, quickly came self harming urges, doctor said its only anxiety in my head. Then suicidal urges, I finished up in hospital, they put me off, the withdrawal reactions was terrible, more terrible than taking the drug. they put me on mirtazapine to stop it, but it was more horrible, violent urges and so on. They say its not possible, but put me off, today a doctor said that being 6 days off is enough and that the problem is me. It is not, but they dont believe me. Dont you have any idea how long akathisia in withdrawal can last? Does it go away I cant live with these thougts…thanks

    1. Alena,

      I’m sorry to hear about your struggles. The doctors have a VERY hard time admitting to meds causing such problems. Why? Because it’s their bread n butter, so to speak. Don’t let him lay this on you! I’m not a doctor, but from the people I’m constantly getting emails from and from my own personal experience, I KNOW horrible terror and crazy thoughts can very much be a side effect of meds, whether you’re currently taking them or several months after stopping. It absolutely sounds like you’re dealing with a lingering side effect. To say it’s just your brain is crazy. It’s very likely your brain wouldn’t have gone there had you not been put on the meds in the first place. Akathisia can last a few days or several months. From what I’ve seen, it really depends on what meds you’ve taken, how long you were on them and how structured you are with your recovery plan. It will go away, but you need to first come to some level of acceptance that this is something you’re going to deal with for a bit and get focused on everything you can do to help your body and brain help itself. The more you fret about your current state and the more you allow anxiety about the anxiety to take up time in your thoughts, the longer your healing process will take. So PLEASE have FAITH in your body’s capacity to HEAL 🙂 and review all the advice I give for speeding healing at the bottom of my blog.

      My thoughts are with you,
      Angie

    2. Are there any known true experts on akathisia that we can ask our own doctors to consult with on our cases? That would sure be helpful for those of us who don’t have access to big cities where there are many more physicians to choose from. Thanks.

    3. I wish! A couple years ago I tried to contact a man who did research on Akathisia, but never heard back from him. I’m guessing because there’s little profit in helping people with Akathisia, or even in studying it, it just isn’t something anyone is in a hurry to work with. I am always asking people to let me know if they find a knowledgeable physician, but never get any replies. So let’s put the call out there here on the blog – IF ANYONE IS, OR KNOWS ANYONE WHO IS, WORKING IN AKATHISIA RESEARCH OR A PHYSICIAN (Allopathic or Alternative), OR PHARMACIST WILLING TO WORK AS A PHONE CONSULTANT FOR FOLKS SUFFERING AKATHISIA, PLEASE LET US KNOW. I would be more than happy to post their information here on the blog if so…

  27. Be careful ! This also happens to me with anesthesia but every medication u mention brings on severe dystonia Benydryl, Valium , adavan diazepam decongestants the list goes on and on , web site … We move or live in pain also help compile if U may suffer from multiple movement diorders. God bless

    1. Yes, agreed. After the years of research I’ve done I realize most EVERY med has the potential. The thing is, these things I noted as possibly being helpful seem to have a lesser risk for Akathisia. But people should definitely be aware most every drug has this awful potential side effect. Anesthesia for sure, because it’s a grand cocktail of many meds. Thank you for the input.

  28. Thank you for this blog. I was put on Abilify in 2009. I tried to get off of it in 2010 and found that I suffered with horrible akathisia. I tried everything from Klonopin, Ativan, Requip, Lortab to get rid of it. It went on for months. Finally, I desperately went back on the medication and the akathisia went away. As long as I take Abilify every other day, I’m not bothered by the akathisia. No doctors seem to believe me. They say that Abilify is known to CAUSE akathisia while on the drug, but should stop when the drug is stopped. I’m just the opposite. The drug that seemed to have caused it also is the only thing that seemingly helps it! I’ve been trying for the past 2 years to get off of it and I just can’t. One time I went without it and within a week, after NO sleep, I ended up in the ER with suicidal thoughts. That is something that I NEVER struggle with outside the akathisia. It’s the most awful feeling in the world! I’m so grateful to find someone who understands. I currently take 1 mg of Abilify every other day without any problems, but I hate having to take it. I feel trapped and addicted to this medication.

    1. Jodi,

      It always amazes me when I hear about more and more doctors who turn a blind eye to this phenomenon. Especially in your case, because it’s very well known that Akathisia can be brought on by certain drug withdrawal, most certainly by anti-psychotics and antidepressants. The longer you have been taking the offending med, generally the longer it takes to overcome the Akathisia once you have stopped the drug. This is why so many people end up in this vicious loop of dependence.

      I would think the only way to get off the drug altogether would be to slowly decrease the amount you’re taking through a very long stretch of time. I wouldn’t recommend doing this on your own, but under the care of a CARING and KNOWLEDGEABLE doctor. There are very few doctors willing to fully admit to the prevalence of Akathisia because frankly, big pharma is their bread n butter, so to speak..but there are a few good doctors out there who get it and do care, if you search hard enough to find them.

      If you dig around this blog, I (and others) have posted a few great research articles, written by scientists/doctors who really understand. I’d say do all the research you can on your own and look for someone (a neuropsychiatrist, neurologist, psychiatrist or maybe general MD) who can help you through this process.

      I’m very sorry to hear of all the trouble you’ve had. The best I know to do is keep communication open and honest between ourselves and try to help one another. Educate everyone you can on this, because ultimately our health care is in our own hands since most doctors care more about turning a profit than actually healing and helping their patients.

      Please keep in touch and post updates so everyone else can learn what you’ve learned through the process.

      I’m still looking for a health professional willing to help guide my readers…but have yet to find someone willing to put their neck out for the cause.

      I wish you all the best and if there’s anything I can do feel free to ask.
      Angie

  29. It’s been 7months for me for the last 2weeks I got a little relief the last 2 days it has hit hard tonight is so bad I’ve been shivering all night I’m tired but can’t sleep body buzzing yawning none stop

    1. Hi Rhonda I’m 11 months into this. I still get hit in waves. I see some improvement But it’s been a long road hopefully I will round that corner and get out of this. I also get small windows on a positive note But most the time it’s always there mild or extreme. Rite now I’m lying in bed weighting this. That’s a plus. How is your progress?

    2. Ray, I’m glad to hear you are making some improvement. It is the hardest thing I have ever experienced as well. It does come in waves. I had been doing great for almost 6 weeks and had a recent episode that has lasted for over a week now. I have gone out today and bought the Natural Calm that Angie recommended and am going to give it a try tonight. I just try and focus on the fact that it is getting better overall and look forward to when it is completely gone. I also do best when I stay busy. Work, being out of the house, and walking helps quite a bit. Best of luck on your continued recovery.

  30. I just wanted to say that you have no idea how much I appreciate you and all the info you have posted here. For someone who had never experienced anything like this before it was earth-shattering. For me it has been right at 7 months. I have seen lots of progress and am looking forward to being me again soon. I find that walking, talking about this with my fiance and family and of course, you, has helped me greatly. I also pray alot. Without this info I am afraid I would have simply thought I was having a mental breakdown and resorted to medication. It is a tough battle, but one I am determined to win.

    1. I’m so glad to hear you’re on the road to being free from this! Every bit of info we share with each other helps I think.
      Thank you.

      Angie

    2. Ray, First let me say thanks for asking. It is always wonderful to have people concerned and supporting who understands what you are going through.

      As far as my recovery, I feel that it is getting better all the time. I still have days that when I am in the midst of them make it seem as though I will never be myself again. But then it passes, and when I look back on them it doesn’t seem quite so bad. I think the worst part is the doubt that I am getting better that these days cause. With that being said the depression part is pretty much completely gone and I am left with anxiety (that too is improving greatly). It has been a roller coaster ride for sure. I hope things are getting better for you as well.

    3. Hi rhonda it’s been a month just wanted to see how your doing. As for me some days I fill the progress. The other days no progress at all. It’s been 10 months. I could sit down and watch tv. For a bit. I sleep 4 Days out of 7. This all started at the end of may. But it took 10 months to make that progress. But some days it kicks in hard

    4. Ray, So good to hear you are making progress. I will once again say that this is the hardest and most bizarre thing I have ever experienced. I am so much better and hope that you will be saying the same thing too very soon. At this point I am 10 months into this ordeal. The depression and dark thoughts are completely gone it seems (anyone going through this understands it fools you sometimes into thinking its gone only to return to beat you up some more) and has been for some time now. The anxiety is also getting much better now (mostly triggered now due to stressful situations, usually work). My last bad anxiety situation was in April. Since then it has improved greatly. I try and keep busy and keep a positive attitude. When I start getting too down, I email Angie and she gives me the encouragement I need to now this is what it is now but that it doesn’t stay this way. I know too though that when in the midst of this it seems hopeless but it feels amazing when you realize you are turning the corner to being yourself again. Please keep in touch with your progress and thanks for asking about mine.
      Rhonda

    5. Hi Rhonda how is it going. I’m 14 months since this started I’ve been stuck since march no big change its fustrating. I’ve been hit hard the last 4 weeks. 24/7. I hope your doing better

    6. Hi Ray,

      Our reactions happened around the same time apparently,as August 5th was my one year mark. I am having more good days than bad lately. I did have a bout that sent me briefly for a tailspin about 2 months ago but recovered pretty quickly. My problem these days seem to be letting go of the guilt over the dark thoughts I had in the past. I sometimes let myself get caught in a cycle of obsessing over them and beating myself up rather than realizing I have come a long way since then. I am trying to control things before they get out of hand these days by practicing breathing techniques when I feel myself becoming anxious and trying to live in the moment. This is easier said than done, trust me I know. I also talk to my fiance alot about things that I am going through which helps me greatly. Do you have someone that you can talk to about what you are going through? I know it’s hard because no one can understand if they haven’t been there. Always feel free to email me as I am always happy to hear from you.

  31. I have had akathesia for 6.5 months it seems to get worse as time goes on I eat healthy im on a glutin free diet I did a sauna detox for a month I juice my brain dont want to get better for any of you guys out there did it peak before it got better how did it stop for you guys and what helped you thru this without prolonging this pain

    1. Ray, I haven’t heard from you lately, but was wondering how you are progressing. How you are doing well. Merry Christmas!

    2. Hi Rhonda I’m still around akathisia still there. I fill changes tho I’m able to sleep and watch tv now but but the darn filling is always there. But not where it was in July I hope your doing good.

  32. Hi,
    Thank-you for making this information available to the public. I was put on 10mg zyprexa as well as 100mg sertraline 4 weeks ago due to my mind racing at night and suffering anxiety. I ended up in hospital a week later suffering from terrible fear, anxiety and the terrifying feeling I was going crazy- the doctors told me to go off the sertraline and continue the zyprexa to help me sleep which I have done for the last 4 weeks. The horrible feeling of being “afraid” and the “un-contentness” has continued the whole time which my therapist has just put down to anxiety although he has said it’s strange that it lasts all day. I have had periods of several days at a time where I feel OK- only to end up with the “anxiety” feelings for several days following- can you tell me if this is a normal scenario for this condition- I’m beside myself with worry as I feel completly out of control. I will definately be reducing the 5mg’s I’m currently taking to 2.5 mg’s per day.
    Thanks again.

  33. Hi,

    I’ve written before several times. Unfortunately, I will have been plagued with chronic akathisia for 2 years in March 2012, and I’m really weary of having to deal with it every day. I wondered if you have learned anything new in the past year?

    I currently take 3 doses per day of inderal (40 mg NON-long-acting, TID) and ropinerole (.5 mg TID), to keep the symptoms from being their worst. I never stop feeling on edge, and I never really feel like ‘myself’ unless –and this is really odd– I am ill with a cold or flu bug. Then, the akathisia symptoms seem to lessen to the point where I can even miss a few doses of meds, oddly enough. I don’t know why on earth this would be the result, but it has happened every time I have had a cold or bronchitis. The only thing I can think of is perhaps the cold medicines I take have something to do with it, which are either Mucinex or Dayquil. I try not to ever take any other medications, because my body will get akathisia between doses of inderal & ropinerole if I do. I can’t even take the homeopathic “Restful Legs” remedy without incurring more symptoms. I feel trapped and victimized by this awful condition, and want nothing more than to be free of it.

    I wanted to ask you about something you said before:

    ” The ER nurse told me to take 50mg every 4-5 hours, for a few days. Even if you are feeling relief from the first dosage some say you need to carry on with treatment for a few days, to prevent relapse. (Which, unfortunately, I am very aware is possible. I relapsed twice within a three week period. So just know it’s possible.) ”

    –What I wanted to ask you is this: Do you think I may have tried to go off akathisia meds in the wrong way before and that is why it didn’t work for me? I’ve tried weaning off 1 med at a time, weaning off 3 doses to less than 3 doses per day, then stretching out the time between doses until they are days apart, but it just hasn’t worked for me. My doctors are clueless about akathisia, and are no help at all. I have tried several times to go off the Inderal & Ropinerole, and each time was absolutely miserable. I was unable to sleep, had to pace continuously, and was jumpier than a cat on a hot tin roof; but the worst symptoms were the feelings of terror & doom, I just can’t handle those symptoms at all. After 5 days of still suffering, I would finally feel I had tried my best and reluctantly go back on the meds. I don’t want to have to take these meds for the rest of my life, and I would dearly love to feel like myself again. I never feel truly relaxed with this condition, and my recent bout with bronchitis was almost a relief because for once I at least felt more like myself and not this jumpy person full of anger & angst that the akathisia creates. It is also difficult to go through each day of my life taking drugs that put most people into a deep sleep, but I’m supposed to try to stay awake and live my life. It is so miserable, but not as miserable as untreated akathisia.

    For anyone who might read this and freak out, I got this condition in a rather unique way, from having a history of adult chicken pox with mononucleosis, which caused meningo-encephalitis which nearly killed me. I have had trouble with recurrent akathisia ever since, but nothing as bad or long-lasting as this 2-year long case of it. I wanted to mention that for people who contract this condition & reassure you it is just temporary, so you don’t freak out thinking you’ll end up like me. Unless you had those above conditions at the same time like I did, you are probably having a temporary case of it so please hang in there and stay strong. I wish I could say my case was temporary, too. I wish everybody a quick & full recovery.

    Please, anyone who could offer me any helpful advice, I would greatly appreciate hearing from you. Thank you.

  34. Hello again,
    I just talked to my psychologist and she says what I am feeling is not akathesia. I think she is wrong. I have extreme anxiety and feel terror all the time. I also have panic attacks especially at night when I am trying to relax. However the doctor said she did not see me pacing or have any leg movement and I could keep up a conversation with her which indicated to her I was not experiencing akathesia but paranoia and needed to take more mess. When I tried increasing haldol the symptoms only became worse. If this is not akathesia I don’t know what it is or how to treat it. Now she wants to put me on resperidol or zyprexa. Will this help? Or will it make it worse? Can you stop akathesia by changing the antipychotic?

    1. I wish I was a doctor, but I’m not. It’s impossible for me to know what drugs will have what affect, I’m not sure even the doctors know honestly. As I told John, I will reply to you in private, but feel free to update your story as you see fit.

      Thank you for sharing,
      Angie

    2. Its important to remember that haldol is known to cause akathisia. Also, akathisia can come about either as a side effect if the medication, or from its withdrawals. Im a little sketchy if what I and many other people experienced is actually akathisia, since the medical industry defines it as a restless leg syndrome. What we experience is also panic, anxiety, feelings of doom, etc. This may be “discontinuation” symptoms that dont (YET) have a name for it. Remember it took over 30 years to recognize the addictive nature and the withdrawals for the benzodiazpines. A well known psyciatrist Dr. David Healy who is an expert witness in many suits against the drug companies states that many people who reinstate the drug find no relief or need to increase the dosage to remove the withdrawal symptoms, especially if too much time has passed being off of the med. By the way, antipsycotics and akathisia are much more frequent than akathisia and ssris.

    3. Respectfully John, I don’t agree that Akathisia is only the physical restlessness. I’ve studied way too many reports and research papers to believe that. I can tell you, as a psychology student, the DSM simply has the wrong criteria and many people go by this reference manual. Hopefully with the new edition coming out soon they will update it! I’m going to cut and paste a huge research paper here now..it’s one of the BEST I’ve ever read. Very informative and thorough.

      Akathisia: Problem of History or Concern of Today
      Naveed Iqbal, MD, Tim Lambert, BSc, MBBS, PhD, FRANZCP, and Prakash Masand, MD

      CNS Spectr. 2007;12(9 Suppl 14):1-16

      An expert panel review of clinical challenges in psychiatry
      This expert roundtable supplement is based on
      an i3 CME presentation held February 6, 2007, in
      New York City. Both the presentation and this supplement are supported by an educational grant from Bristol-Myers Squibb.

      Accreditation Statement/Credit Designation
      i3 CME is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

      i3 CME designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit.TM Physicians should only claim credit commensurate with the extent of their participation in the activity.

      The University of Florida College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This activity is approved for 1 contact hour (0.1 CEU) in states that recognize ACPE.

      To receive enduring credit, you must pass the post test with a score of at least 70% and complete the evaluation form. Statements of CE Credit will be issued by the University of Florida College of Pharmacy upon proof of successful completion of the activity. (Enduring 012-999-06-184-L01).

      i3 CME is an approved provider of continuing nursing education by the Utah Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. The participant will be awarded 1 contact hour of credit for attendance and completion of supplemental materials.

      i3 CME is approved by the American Psychological Association to sponsor continuing education for psychologists. i3 CME maintains responsibility for this program and its content. The participant will be awarded 1 contact hour of credit for completion of the quiz and evaluation form.

      This activity has been approved to provide 1 hour of CE for case managers by the Commission for Case Manager Certification (CCMC).
      Target Audience
      This activity is designed to meet the educational needs of physicians, pharmacists, nurses, psychologists, and case managers.
      Learning Objectives
      • Identify main points of the pathophysiology of drug-induced movement disorders with a focus on akathisia
      • Recognize the signs and symptoms of drug-induced movement disorders, particularly drug-induced akathisia
      • Select an appropriate strategy for preventing or alleviating movement disorders associated with neuroleptic treatment with a focus on akathisia
      Faculty Affiliations and Disclosures
      Dr. Iqbal is associate professor of clinical psychiatry at Albert Einstein College of Medicine in Bronx, New York, and director of research at Advanced Bio-Behavioral Sciences in Elmsford, New York. Dr. Iqbal is a consultant to and on the advisory boards of Bristol-Myers Squibb, Otsuka, and Janssen; is on the speaker’s bureaus of AstraZeneca, Bristol-Myers Squibb, Janssen, and Otsuka; and receives grant/research support from AstraZeneca, Bristol-Myers Squibb, Janssen, Memory, Otsuka, and Pfizer.

      Dr. Lambert is professor of psychological medicine at the University of Sydney and Head of Schizophrenia Treatments and Outcomes Research at the Brain and Mind Research Institute, Sydney. Dr. Lambert is a consultant to and is on the advisory boards and speaker’s bureaus of Bristol-Myers Squibb, Eli Lilly, Janssen, Pfizer, AstraZeneca and Mayne Pharma; and receives grant/research support from Bristol-Myers Squibb and Janssen.

      Dr. Masand is consulting professor of psychiatry at Duke University Medical Center in Durham, North Carolina. Dr. Masand is a consultant to Alkermes, Bristol-Myers Squibb, Cephalon, Eli Lilly, Forest, GlaxoSmithKline, Janssen, Jazz, Organon, Pfizer, Targacept, and Wyeth; is on the speaker’s bureaus of AstraZeneca, Bristol-Myers Squibb, Forest, GlaxoSmithKline, Janssen, Pfizer, and Wyeth; and receives grant/research support from AstraZeneca, Bristol-Myers Squibb, Cephalon, Eli Lilly, Forest, GlaxoSmithKline, Ortho-McNeil, Janssen, and Wyeth.
      Acknowledgment of Commercial Support
      This activity has been supported by an educational grant to i3 CME from Bristol-Myers Squibb.
      To Receive Credit for this Activity
      Read this expert roundtable supplement, reflect on the information presented, and take the CME quiz on page 14. Complete the answer form and evaluation on page 15 and return it to: i3 CME, 180 Regent Court, Suite 50, State College, PA 16801.

      To obtain credit, you should score 70% or better. Termination date: September 30, 2009. The estimated time to complete this activity is 1 hour.
      Abstract
      Akathisia is a neurological side effect of antipsychotic medications, which are used to treat various psychiatric disorders. Akathisia is characterized by physical restlessness and a subjective urge to move. Although side effects such as akathisia, dystonia, and dyskinesia are common with the use of conventional antipsychotics, they occur in reduced frequency with the use of new-generation antipsychotics. Despite a lowered incidence profile, akathisia and similar conditions continue to affect patients. Neuroleptic-induced akathisia can present as fidgety movements while seated, rocking in place while standing, pacing, inability to sit or stand still for an extended period of time, and an overwhelming urge to move. These symptoms can cause severe distress and an increased risk of suicide for affected patients. First-line treatment of akathisia includes benzodiazepines or ß-blockers for patients who do not have symptoms of Parkinson’s disease and anticholinergic medications for patients with Parkinson’s symptoms. Clinicians should ensure that an accurate diagnosis of akathisia is made and that target symptoms are decreasing due to treatment. At the same time, it must be ensured that the treatment used does not negatively affect the mental health of the patient. This expert roundtable supplement will address the diagnosis, pathophysiology, phenomenology, classification, and history of akathisia as well as discuss screening tools and treatment options for the condition.
      Akathisia: Problem of History or Concern of Today
      Introduction
      New-generation antipsychotics have largely replaced conventional medications for the treatment of various psychiatric disorders, largely due to their more favorable neurological side-effect profiles. Adverse events associated with older medications, such as akathisia, are less common with atypical antipsychotics, although they are not completely absent. All of the atypicals have the potential to cause akathisia. In addition, although newer medications are generally better tolerated, they come with their own set of specific side effects. While the focus of this discussion is largely on the neurological side effect akathisia, others of concern to clinicians include metabolic effects, hyperprolactinemia, sexual dysfunction, and extrapyramidal side effects (EPS).
      FDA Indications for Atypical Antipsychotics
      Atypical antipsychotics are approved by the United States Food and Drug Administration for various indications (Slide 1). For example, risperidone has indications for acute mania and mixed episodes of bipolar disorder, but is not indicated for maintenance treatment of bipolar disorder. Olanzapine and aripiprazole are approved for acute mania and mixed episodes as well as maintenance of bipolar disorder. Quetiapine is not approved for mixed episodes or maintenance, but is approved for acute mania and is the only atypical agent approved for acute depression. Because of their varied FDA indications, it is important for clinicians to understand the differences between these medications and their uses.

      Clinicians also often use atypical antipsychotics for off-label purposes, including dementia with agitation and psychosis in the elderly population, a broad spectrum of childhood disorders, treatment-resistant mood disorders, major depressive disorder (MDD), and obsessive-compulsive disorder (OCD). In view of the significant off-label use of atypical antipsychotics for other conditions, many believe the term “antipsychotic” to be a misnomer. The term antipsychotic is also thought to cause patients to be reticent to use these agents for non-psychotic illnesses, such as MDD, OCD, or other treatment-refractory conditions.
      Common Side Effects of Atypical Antipsychotics
      Atypical antipsychotics have a more favorable side-effect profile than conventional antipsychotics, but they do possess side effects specific to their class. There are ~40 common antipsychotic-induced side effects, including psychic effects such as somnolence and fatigue, and cognitive effects such as neuroleptic-induced deficits. Some of the most well-known are akathisia, parkinsonism, dystonia, weight gain, dyslipidemias, cardiovascular problems, hyperprolactinemia, and sexual dysfunction (Slide 2).

      EPS occurs less frequently with second-generation antipsychotics than with conventional antipsychotics: 60% to 65% of patients treated with conventional antipsychotics have experienced EPS.1,2 EPS can include akathisia, dystonia, akinesia, and/or tardive dyskinesia (TD). An analysis of 1-year studies examining second-generation antipsychotics and rates of TD demonstrated that conventional drugs were associated with a 5.2% rate of newly emergent TD symptoms within 1 year of treatment; this rate was 2.1% in patients taking second-generation antipsychotics.3

      Confounding variables to these studies include use of non drug-naive patients, which defies the true prevalence of some of these side effects because of pretreatment or other issues. For example, withdrawal TD can occur anywhere from ~6 weeks to 6 months following the cessation of previous treatment, particularly if that treatment was a first-generation medication. While a side effect may be discovered over a 1-year period, it is quite difficult to determine if this incident was not due to prior TD that had been suppressed by previous medication use. The only way to determine true TD prevalence rates for a particular medication is by taking a cohort of first-episode, drug-naive patients and following their progress for 5 years. In the available studies, the rate of TD has been demonstrated to be lower with second-generation drugs—by how much less remains unknown.4

      It has consistently been found that dosage—particularly with some of the second-generation antipsychotics—is related to an increased rate of akathisia. However, there are several variables that can significantly impact whether clinicians perceive akathisia to be a result of treatment with second-generation antipsychotics. Some factors clinicians consider is whether the presentation is true akathisia or pseudoakathisia, whether the medication switch occurred too quickly, and whether a psychotic anxiety is present together with the akathisia.
      Current Confounds in Akathisia Research
      In the past, Parkinsonism was established as a neuroleptic side effect, while clinicians paid little attention to akathisia. Today, many clinicians believe that akathisia is a motor phenomenon and that motor signs must be present for its diagnosis. This poses a problem because the majority of disability suffered by patients is subjective. Although estimation of the subjective components is essential for diagnosis, clinicians often do not ask their patients about it. Because diagnosis is driven by physical symptoms and not the mental problems caused by the desire to move, prevalence rates in studies are typically under-represented.

      Another factor that confounds research concerns the point at which akathisia is measured. Many researchers have examined subjective and objective akathisia during an evaluation that generally occurs 2 weeks after establishing treatment with first-generation medications. The average rate at 2 weeks was 39%, which is typically slightly higher in the first week and reduces in severity over the next several weeks (T. Lambert, PhD, unpublished data, 1995). Clinical practice and reviewed studies indicate that 30% may be closer to the actual rate of akathisia measured over a treatment period.5

      In addition, all atypical antipsychotics are not the same. Although all of them have the potential to cause akathisia, some may be more likely to cause akathisia and/or other EPS. Different drug classes, particularly serotonin-dopamine antagonists, have a more distinct dose-response curve because they are intensive dopamine blockers with their EPS partially modified at lower doses by serotonin (5-HT)2A blockade. For example, with risperidone, akathisia can be detected beginning at dosages of ~3 mg and increasing from that point. Although olanzapine appears to be relatively EPS-free, onset of akathisia is noted as patients take higher doses. Some of the other serotonin-dopamine antagonists, such as clozapine, are reported to be free of side effects, but clinicians demonstrate clear akathisia in ~7% of patients taking the drug. Side effects also exist with the second-generation antipsychotics, even with faster “on-off” drugs, such as clozapine and quetiapine.6 As doses increase, so does the likelihood of adverse effects.
      History of Akathisia
      It is thought that akathisia has been recognized in some form for more than a century (Slide 3). The term akathisia derives from the Greek term meaning “not to sit still.” Since the advent of the antipsychotics, the term akathisia is becoming more associated with the use of these medications, despite the fact that the syndrome exists with other drugs and in other neurological states. Theodore Van Putten was the first to identify subtle subjective akathisia as a behaviorally toxic component of psychosis treatment. The condition was identified as one that distresses the patient, causes morbidity, and leads to poor outcomes. This distinction is important because the concept of akathisia has developed over time from a condition of straightforward movement of the legs to a complicated intra-psychic and motor disorder that involves distress.7

      While it is now known that subjective aspects may dominate without any motoric abnormality, the diagnosis is often missed because many clinicians still mistakenly believe that akathisia is not present unless the legs are moving. The psychological components of akathisia are often mistaken for other conditions. Clinicians tend to rely more on objective manifestations when it comes to movement disorders. This attitude may be related the narrow diagnostic criteria for akathisia depicted in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).8
      Pathophysiology of Akathisia
      The pathophysiology of akathisia may involve dopamine, acetylcholine, γ-aminobutyric acid (GABA), norepinephrine, serotonin, and neuropeptides (Slide 4). Dopamine antagonism impacts various neurotransmitters and directly correlates with EPS. For example, dopamine antagonism may affect GABA in the pallidus or norepinephrine in the locus ceruleus (Slide 5).9

      Some have questioned whether akathisia is simply a dopamine blockade. While clinicians tend to examine neurotransmitters in isolation, medications often have indirect effects on other neurotransmitters. Therefore, when researchers search for new medications to treat psychosis or schizophrenia, they often focus on medications that do not predominantly produce dopamine blockade but may produce it indirectly through the glutamate system or the GABAergic system or the cholinergic system. For example, adding a 5-HT2A postsynaptic blocker improves negative symptoms, presumably by increasing dopamine in the prefrontal cortex. In this model, EPS defined strictly as rigidity due to Parkinson’s disease improves, although akathisia does not.10 The fact that akathisia prevalence has not changed in such studies suggests that there is an extradopaminergic mechanism involved (Slide 6).

      Another factor to consider is that clozapine, a very weakly-bound agent, and quetiapine, which has virtually no features of Parkinsonism at normal doses, may also cause akathisia in the absence of other EPS.11 This suggests that there is another mechanism involved in akathisia.

      In addition, tardive akathisia has been reported to improve with moclobemide treatment.12 This indicates that the mechanism involved may be inhibition of adrenergic function in the presence of supersensitive mesocortical dopaminergic systems.

      Finally, in the elderly, akathisia can be completely divorced from the appearance of Parkinson’s disease.13 However, some of the treatments currently employed do tend to have an effect on the adrenergic system, rather than the dopamine cholinergic system. Researchers suspect that dopamine blockade is necessary in the development of akathisia but not sufficient to wholly explain this condition. Different areas of the brain and different circuits need to be examined.

      Slide 7 illustrates the circuitry that is used to explain EPS.14 There are two pathways out of the basal ganglia—the direct pathway and the indirect pathway. Changes in the direct pathway typically involve consequences that are dyskinetic, while changes in the indirect pathway tend to have consequences related to symptoms of Parkinsonism disease. Unfortunately, there is no clear way of understanding where akathisia fits into this model. There are inputs into the system from 5-HT and the noradrenergic system. However, this model is driven as a GABA system, with dopamine and other neurotransmitters acting as modulators. Because the model offers no explanation for akathisia, many feel that investigators should move away from this model in their current akathisia research.

      Classification of Akathisia
      The classification of akathisia continues to be problematic, and there is much disagreement among the experts. Slide 8 lists the symptoms of various classifications of akathisia, including neuroleptic-induced akathisias such as acute akathisia, pseudoakathisia, and chronic akathisias type 1 and 2 as well as other forms of the condition such as hysterial akathisia and spontaneous akathisia.15

      Currently, clinicians classify akathisia based on a drug’s akathisic potential, or changing medications that have or do not have akathisic potential. This practice is problematic because clinicians often see chronic akathisia or persistent akathisia. It is difficult for the clinician to determine whether the patient has so-called chronic primary akathisia that was not detected initially but has been present, or late-appearing tardive akathisia that has appeared after some months of treatment.

      This is also important because some cases of tardive akathisia may be a form of TD rather than akathisia. Symptoms may be due to withdrawal dyskinesia from previous treatment, or may represent a different type of entity than what clinicians understand akathisia to be in its acute form. There is much debate about the meaning of the tardive akathisic group of symptoms. The symptoms often to not respond like acute akathisia, which suggests involvement of a different mechanism and that these symptoms are from a related family of movement disorders (Slide 9).

      Phenomenology of Akathisia
      According to the DSM-IV, the essential features of neuroleptic-induced acute akathisia are subjective complaints of restlessness and at least one of the following observed movements: fidgety movements or swinging of the legs while seated, rocking from foot to foot or “walking on the spot” while standing, pacing to relieve the restlessness, or an inability to sit or stand still for at least several minutes.7

      Akathisia is thought to consist of three tripartite components—subjective akathisia, distress, and motor phenomena. Subjective akathisia has been reported for a long period of time. An essential component is a subjective feeling of restlessness, which patients can often distinguish from agitation. Many times, patients are able to differentiate between the tremulousness caused by anxiety from that caused by akathisia based on the distinct quality of akathisia. This is similar to what many patients are able to do when they differentiate the feelings of everyday sadness secondary to life events from the distinct quality of the feeling of depression. These symptoms can also lead to severe distress or akathisic distress, which not uncommonly is associated with suicidality.

      The motor phenomenon of akathisia may present as moving in the same spot, pacing up and down, and/or being fidgety.8 Depending on which definition a clinician adopts, either within the United States or outside, criteria for the full syndrome would include subjective akathisia plus either distress, motor phenomena, or both.

      Some patients can repress their need to move around, which affects the akathisia diagnosis. Interestingly, patients with TD can suppress their movements for short periods if they are forced to do so, although they are involuntary movements. Another interesting aspect of akathisia, discovered in years past, is that patients often lie flat on the floor in hospitals and wards and press their hands and feet to the floor. The patients reported that this behavior was the only way they could cope with the restlessness. They described themselves as “grounding themselves.” Thus, motor phenomena may not always be the same, just as dystonia may fluctuate in presence. However, the subjective component is always present from the beginning (Slide 10, 11).

      Akathisic distress is also variable. Some patients have become inured to the subjective feelings of needing to move and have stopped being distressed. These patients may even lose their motor movements to a degree. However, the subjective component stays. Patients who have the motor phenomena and express no subjective concern over the movements at all have pseudoakathisia. These patients may represent a different entity altogether, when compared to acute akathisia.

      In severe cases and even moderate cases, patients report experiencing “a horrible feeling,” which causes agitation and spurs them to try to rid themselves of negative energy. Patients’ psychosis can appear to worsen because they are becoming agitated. Many patients begin to increase their substance use to suppress symptoms, which has been linked to increased risk of TD (Slide 12).16,17

      Differential Diagnosis of Akathisia
      There are various screening instruments available for clinicians to use in diagnosing akathisia. The Barnes Akathisia Rating Scale (BARS) is administered by physicians to assess the severity of drug-induced akathisia (Slide 13). BARS items consist of objective, subjective (awareness of restlessness, distress related to restlessness), and global clinical assessment of akathisia.18 While the BARS scale is probably the most widely used, the tool requires training prior to use. There are a variety of other scales that have also been developed. The large scale-screening tool, General Akathisia Tardive Phenomena and Extrapyramidal Scale (GATES), has two brief spin-off tools that deal with subjective and objective akathisia.19 Slide 14 features the objective component of this tool.

      Tardive akathisia is characterized by longer-term akathisia manifestations, which develops after ≥3 months of treatment (Slide 15). It is occasionally confused with chronic akathisia, but the chronic form begins earlier and continues beyond 3 months. Tardive akathisia is accompanied by motor phenomena associated with dyskinesia (which is poorly responsive to anticholinergic treatments). It persists or in some cases, gets worse, when antipsychotic treatment is discontinued or reduced. Tardive akathisia may not be accompanied by subjective akathisia and in that case would be classified by the BARS as pseudo-akathisia.

      Other conditions often confused with akathisia include the activation syndrome that clinicians occasionally see with use of atypical antipsychotics, particularly some new partial dopamine agonists. This is most likely not akathisia as patients often do not report subjective statements such as “my legs are pushing me to move around and I need to do this to make myself feel better.” In addition, ß-blockers have no effect for these patients and their responsiveness to benzodiazepines is a time-limited phenomena. The absence of Parkinson’s disease symptoms also suggests this condition is different from akathisia. Akathisia can be differentiated from activation by seeking information from patient about inner, pervasive restlessness, which is very characteristic of akathisia. Progressive restlessness and tremulousness while sitting can help clinicians separate between activation and akathisia.

      Drug withdrawal states are common differential diagnoses. Withdrawal from substances such as opiates or cannabis can lead to akathisia-like movement and restlessness. Restless leg syndrome and TD are also mistaken for akathisia (Slide 16).

      Treatment Options for Akathisia
      Benzodiazepines or ß-blockers are first-line treatments for akathisia. If the clinician believes that the akathisia is a noradrenergic phenomena, a ß-blocker would be considered first. A second choice would be a benzodiazepine at the routine, clinical, standard dose. Careful dose reduction that does not compromise the treatment efficacy is encouraged.
      Patients who have symptoms of Parkinsonism together with akathisia (approximately 65% of patients may have both presentations) may respond to anticholinergic medications (Slide 17). The same dose typically used of benztropine or similar medications, should be used for anticholinergic therapy in this situation.

      The less common strategies include the 5-HT2 antagonists in the 10–30 mg dose range, 5-HT1 partial agonists, and dopamine reuptake inhibitors (Slide 18).

      Conclusion
      Akathisia has been such an elusive phenomena that a sharp focus on this condition is extremely important. Identifying and diagnosing akathisia can be quite difficult, and standardized scales can be very useful. It is also beneficial to distinguish between different types of akathisia, such as chronic versus spontaneous, in order to determine appropriate treatment. In addition, it is important to distinguish akathisia from activation or psychotic anxiety. Dopamine may not be the only neurotransmitter involved in akathisia. GABA, acetylcholine, and norepinephrine are involved as well. This must be considered in choosing treatment options (Slide 19).

      From a clinical point of view, it is essential that clinicians feel comfortable measuring all three components of akathisia—subjective, distress, and motor. Both an interview and examination are necessary, rather than observation alone. Subjective akathisia is typically present before motor signs. A patient may have intense distress with no movements or no subjective distress with severe movement.

      Lipophilic ß-blockers (eg, propranolol) are the best treatment for patients who do not have symptoms of Parkinsonism and anticholinergics are best when akathisia is accompanied by Parkinsonian symptoms. In patients with chronic, persistent akathisia or short-term acute akathisia, benzodiazepines are considered first-line treatment followed by clonidine. The treatment model must consider the risk-benefit ratio before undertaking dose reductions or concomitant treatment. The clinician should ensure that target symptoms are in fact decreasing with antidotes—consistent use of instruments is recommended.
      References
      1. Vieta E, Bourin M, Sanchez R, et al. Effectiveness of aripiprazole v. haloperidol in acute bipolar mania: double-blind, randomised, comparative 12-week trial. Br J Psychiatry. 2005;187:235-242.
      2. McIntyre RS, Brecher M, Paulsson B, Huizar K, Mullen J. Quetiapine or haloperidol as monotherapy for bipolar mania–a 12-week, double-blind, randomised, parallel-group, placebo-controlled trial. Eur Neuropsychopharmacol. 2005;15(5):573-585.
      3. Correl CU, Leucht S, Kane JM. Lower risk for tardive dyskinesia associated with second-generation antipsychotics: a systematic review of 1-year studies. Am J Psychiatry. 2004;161(3):414-425.
      4. Schooler N, et al. Risperdal and haloperidol in first episode psychosis: a long term randomized trial. Am J Psychiatry. 2005;162:947-953.
      5. Jano S, Holi M, Tuiso K, Wahlbeck K. Prevalence of neuroleptic-induced movement disorders in chronic schizophrenia inpatients. Am J Psychiatry. 2004;161:160-163.
      6. Catalano G, et al. Acute akathasia associated with quetiapine. Psychosomatics. 2005;46(4): 291-301.
      7. Sachdev P. The development of the concept of akathisia: a historical overview. Schizophr Res. 1995;16(1):33-45.
      8. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.
      9. Casey DE. Pathophysiology of antipsychotic drug-induced movement disorders. J Clin Psychiatry. 2004;65(suppl 9):25-28.
      10. Wynchank D, Berk M. Efficacy of nefazodone in the treatment of neuroleptic induced extrapyramidal side effects: a double-blind randomised parallel group placebo-controlled trial. Hum Psychopharmacol. 2003;18(4):271-275.
      11. Cohen BM, Keck PE, Satlin A, Cole JO. Prevalence and severity of akathisia in patients on clozapine. Biol Psychiatry. 1991;29(12):1215-1219.
      12. Ebert D, Demling J. Successful treatment of tardive akathisia with moclobemide, a reversible and selective monoamine-oxidase-A inhibitor. A case study. Pharmacopsychiatry. 1991;24(6):229-231.
      13. Sandyk R, Kay SR. The relationship of tardive dyskinesia to positive schizophrenia. Int J Neurosci. 1991;56(1-4):107-139.
      14. Umbricht DS, Kane JM. Understanding the relationship between extrapyramidal side effects and tardive dyskinesia. In: Kane JM, Moller HJ, Awouters F, eds. Serotonin in Antipsychotic Treatment: Mechanisms and Clinical Practice. New York, NY: Marcel Dekker; 1996.
      15. Barnes TR, Braude WM. Akathisia variants and tardive dyskinesia. Arch Gen Psychiatry. 1985;42(9):874-878.
      16. Potvin S, Pampoulova T, Mancini-Marie A, Lipp O, Bouchard RH, Stip E. Increased extrapyramidal symptoms in patients with schizophrenia and a comorbid substance use disorder. J Neurol Neurosurg Psychiatry. 2006;77(6):796-798.
      17. Miller DD, McEvoy JP, Davis SM. Clinical correlates of tardive dyskinesia in schizophrenia: baseline data from the CATIE schizophrenia trial. Schizophr Res. 2005;80(1):33-43.
      18. Barnes TR. A rating scale for drug-induced akathisia. Br J Psychiatry. 1989;154:672-676.
      19. Lambert T. GATES: a new instrument for the clinical and research assessment of neuroleptic-induced movement disorders. Schizophrenia Res. 1998;29(Special Edition):179.
      Question-and-Answer Session
      Q: Is it a true statement that akathisia is a predictor of poor response to treatment?
      Dr. Iqbal: I think it is very true today. Historically, akathisia was seen as a good prognostic indicator. Today, that pharmacodynamic model does not apply. Patients do not have to present with side effects to demonstrate drug efficacy. These side effects have the potential to increase distress to a level where suicide becomes a high risk. Therefore, akathisia is a poor prognostic indicator.
      Q: Atypical antipsychotics are used for treatment-resistant major depression, as in augmentation therapy. Selective serotonin reuptake inhibitors (SSRIs) are often the primary drug used in these patients, with augmentation of atypicals. In adding an atypical, what are some of the clinical pearls that clinicians should be aware of in terms of trying to minimize akathisia and side effects?
      Dr. Lambert: SSRI use in schizophrenia is very common, with 25% of patients taking an agent from this drug class. SSRIs are also used in the treatment of patients with resistant depression. Researchers have long known that a certain proportion of patients become affected with akathisia when taking SSRIs. Sometimes, the akathisia is mistaken as anxiety or acute anxiety. However, when questioned, patients report that they have an intense need to move. In actuality, these patients have classical akathisia. Then we add a drug (an atypical) that may have an individual small propensity to cause akathisia itself. Together, the synergism is such that they get incredibly distressed. The usual thing the doctor says is that the patient stopped taking the medication. In other words, they become overtly non-adherent. When factors that can potentially lead to akathisia are noted, such as a patient’s history of akathisia with either drug, one can consider adding benzodiazepines for 10 days.

      Dr. Masand: The other key is that in major depression, the starting dose of the atypicals might need to be much lower than in schizophrenia.

      Dr. Iqbal: And I think we should also look at the drug-drug interaction as a factor. Because even with a smaller dose, a patient might actually have a much higher level of the drug in their blood.
      Q: Which of the SSRIs are the most likely to cause the akathisia?
      Dr. Iqbal: We do not know of any differences within the SSRIs. All SSRIs, including fluoxetine, paroxetine, sertraline, and citalopram, probably have equal potential to cause akathisia.
      Q: I have found that clonidine works well for akathisia. Eighty-five percent of my patients are on clonidine or guanfacine. Yet, this was cited as second-line treatment in the presentation. Can you comment on that?
      Dr. Lambert: I am a supporter of clonidine. Some patients do not respond to anything else. The medication obviously affects the adrenergic system, and it should probably be used a lot more than it is. If a patient does not achieve success with the ß-blockers within a few days, one should move on to a second-line drug very quickly.

    4. Don’t get me wrong; I agree that akathisia does contain both physical and mental aspects. I’m just trying to point out that many doctors will tell you that it is not akathisia due to lack of movement, since the DSM IV declares it as a movement condition, and will encourage the Drs to diagnose false anxiety disorders or agaitated depression, leading to increased dosages of meds. Rule of thumb is this; if after quitting your meds you find that you have new symptoms; ones that you never had before you began the meds, odds are that it’s the meds, being from withdrawals or side effects. By the way, here’s a long letter of a reply from Dr Healy to a person who asks why his ailments are lasting so long:

      I asked Dr Healy to explain why after 4 + years off Seroxat I was still unwell, he very kindly offered this explanation:

      Background
      It is now generally accepted that antidepressants can cause physical dependence and a withdrawal syndrome, so that stopping antidepressants can commonly lead to withdrawal problems, that these problems may be severe in some instances but are generally less severe, and that these problems may last for months but are more often over within weeks. This piece outlines what is known about states of persisting difficulty and what can be done to remedy them.

      First, it has been known since the 1960s when dependence on and withdrawal from antipsychotics was first outlined that in addition to classic states such as tardive dyskinesia that might be revealed by withdrawal, a variety of stress syndromes and persisting affective disturbances that have been termed tardive dysthymia, tardive akathisia and other tardive syndromes might also emerge.

      Second, by the time enduring problems emerge after antidepressant discontinuation, the character of the initial problem has commonly changed. The initial problems often centre on phenomena that have been termed electric zaps, and electric head, but later these recede into the background and are replaced by a restless or dysphoric state consistent with a tardive dysthymia or tardive akathisia.

      It should be noted that in addition to the abnormalities of sensation common in the initial phases, many of those affected complain of anxiety and depressive symptoms also. It may not be clear to patients or their doctors that these later onset depressive states are new developments, as they may often appear continuous with early onset withdrawal states and may even harder to distinguish from an original depression than the initial withdrawal state was.

      Enduring states of this type can follow discontinuation from almost all antidepressants active on the serotonin system. The problem has not been as apparent on other antidepressants but this may reflect frequency of usage of SSRIs rather than anything else.

      The problems appear more common in women than in men but this again may reflect frequency of usage.

      The characteristic symptoms include “depression”, depersonalisation, agitation/akathisia, a generally labile state and stress intolerance.

      Enduring problems can follow either abrupt or tapered discontinuation of treatment. One difficulty lies in knowing how common such states are.

      A great number of individuals presenting to their doctors with these disorders are in all likelihood being told they have a recurrent affective disorder and are probably commonly being put back on an antidepressant.

      This will happen for three reasons. First the problems will often look “depressive”. Second, most physicians simply do not think that higher order neurological problems of this sort could persist this long. Third, the problems at this point may seem to physicians to be different to the original problems on withdrawal and those affected may be persuaded of this. This interpretation is made more likely by the fact that most people will have had slightly better periods before a bad period leads them to seek help. But even tardive dyskinesia goes through good and bad phases.

      Finally, this scenario overlaps with problems that can appear after stopping benzodiazepines, where the acute phases of withdrawal, which overlap with acute SSRI withdrawal, differed in profile from more chronic syndromes. The profile of chronic post-benzodiazepine difficulties is similar to that of chronic post-SSRI problems, with the chronic syndromes being more apparent in women.

      Treating Severe Discontinuation Difficulties
      In terms of the initial treatment of severe discontinuation difficulties, there are serotonergic and non-serotonergic options.

      The serotonergic options as outlined in a number of withdrawal protocols involve going on a serotonin reuptake inhibitor such as fluoxetine or imipramine, often in liquid form and tapering extremely gradually.

      A second option involves moving to a tricyclic antidepressant or an antihistamine or St John’s Wort on the basis that these share antihistaminic and serotonin reuptake inhibiting properties in common but are less potent (“gentler”) than SSRIs.

      A third option involves treating with agents acting on different systems. Apparent success has been reported with choline-esterase inhibitors or lamotrigine. These have appeared in some instances to ease withdrawal problems in individuals who have found it very difficult to get off treatment.

      Managing Tardive Dysthymia
      The management of tardive dysthymia is a different problem to managing severe withdrawal. At present it is not clear what if anything might help the difficulties some people seem faced with 6 months or more into the discontinuation period.

      Faced with ongoing problems, people commonly ask whether it might be worth going back on the original antidepressant and starting a new and even more gradual taper.

      This seems problematic for two reasons. First going back on something that has caused such difficulties, perhaps through some vulnerability of the taker’s serotonergic or a related system, seems risky.

      Second at least some of those who have gone back on treatment have needed to go back on a higher dose than previously in order to alleviate problems and in some instances a return to the original medication has not alleviated the problem.

      Generally the longer the interval off the drug, the less likely it has been that reinstituting the treatment will lead to a resolution of the symptoms.

      If an individual does return successfully to treatment, the question is what next.

      Based on experience with the management of withdrawal from antipsychotics, one option might be to remain on treatment indefinitely. There are several drawbacks to this.

      In the case of the antidepressants it is not at present known if ongoing treatment increases the risk of premature mortality or other disorder. The risks of fractures or haemorrhages seem slightly increased, and perhaps more substantially increased if combined with other treatments like aspirin.

      If the taker has found the SSRI helpful but also emotionally blunting, this would be a significant impairment to quality of life to have to live with.

      A second option is to turn to an antihistamine, such as chlorpheniramine, or to a tricyclic antidepressant, such as dosulepin or imipramine, or to St John’s Wort. The rationale here that a small amount of serotonin reuptake inhibition is all that is needed to produce a helpful anxiolytic effect in those suited to drugs of this type. SSRIs are in fact almost grotesquely overpowered for the purpose – using one is rather like having a sports car in a 30 mph zone.

      Third turn to a completely different therapeutic principle. Among the options are drugs active on the cholinergic system, calcium channel blockers or dopamine agonists.

      Choline-esterase inhibitors may help tardive dysthymic states, in that they have been reported to offer a benefit in tardive dyskinesia, and have been helpful in some cases of SSRI withdrawal.

      Calcium channel blockers have been reported to benefit some individuals with enduring problems after antipsychotic withdrawal.

      Dopamine agonists or stimulants are used in restless legs and related syndromes, and restlessness is often a component of the problems facing individuals after stopping antidepressants.

      The final point concerns the likely duration of a tardive dysthymic episode. Based on the precedent of tardive dyskinesia, and of the difficulties some patients faced on discontinuation from benzodiazepines such states may last for 1-4 years. In older individuals there is a possibility they may last indefinitely. In younger individuals, they are more likely to clear up in a 12-36 month timeframe.

      The resolution of difficulties may require something like a synthesis of new receptors to replace receptors that have been jettisoned in the face of physiological stressor of the SSRI. Whatever the mechanism recovery does happen but may take years and seems likely to be facilitated by activity of various sorts and most probably an avoidance of psychotropic medication – including antihistamines and other compounds.

      Pregnancy – a Special Consideration
      The issues above are particularly complex for women considering pregnancy, given evidence that serotonin reuptake inhibitors increase the risk of birth defects, spontaneous abortions, primary pulmonary hypertension and neonatal withdrawal syndromes.

      Although more women on antidepressants have perfectly normal babies than have babies with one of the above problems, there is also the issue of the toll that 9 months of worrying might take on a mother and the effect of this on the relationship between mother and child.

      Women contemplating pregnancy or suspecting or finding themselves pregnant and anxious to withdraw may have very real problems in the event of a significant withdrawal. A cross taper to fluoxetine liquid is problematic in that fluoxetine is also linked to an excess of birth defects and the other problems found with Seroxat.

      MANAGEMENT STRATEGIES

      Managing New Affective Episodes
      Another issue that needs to be addressed is the emergence of what is in fact a new affective episode rather than a flare-up of tardive dysthymia.

      In this case, it seems likely that if someone got well on a serotonergic agent in the first instance, they are more likely to show a better initial response to another such agent than they are to respond to an agent from a different class.

      This raises the question of whether the short term benefit is worth taking given the likely longer term problems. To some extent this issue depends on what the alternatives are.

      First if this is a depressive disorder that has responded to a serotonergic agent in the first instance, it is less likely to be severe and as such the risks of attempting to bring about a quick response with drugs – such as the risk of suicide – are not high.

      It would seem best however to take a drug that has less potent serotonin reuptake inhibiting properties – such as imipramine.

      Second, not intervening pharmacologically is a reasonable option for two reasons. One is that the natural history of such disorders is that they will resolve on average within 12-16 weeks. Another is that there is considerable evidence to suggest that those who respond without pharmacological or other interventions are less likely to relapse in future.

      Third, related to not-intervening there are a number of things affected individuals can do for themselves. Exercising, particularly in a routine, is likely to be helpful, as is physical work generally. Diet, especially avoiding alcohol, is likely to be of some importance.

      There are other more esoteric steps a person can take. One is sleep deprivation, which is undertaken regularly as an antidepressant treatment in many European countries.

      Finally, CBT or other psychotherapeutic procedures may be of benefit, where they would seem to be less likely to be helpful in tardive dysthymic states.

      Managing Withdrawal

      A large number of doctors still halt antidepressants abruptly, possibly for 2 reasons. One, they are not aware they should taper the treatment. Second, it is not possible to taper the treatment as only a few drugs come in liquid form – fluoxetine, paroxetine and imipramine. Given that a transfer to fluoxetine liquid can cause its own problems, making liquid forms of all SSRIs available or disseminating information on how such formulations may be prepared is important.

      Patients undergoing a marked withdrawal from antidepressants need an account of what is known about what is happening to them. Something on these lines:
      Your brain has adjusted to the presence of an antidepressant and the removal of this stimulus now requires the brain to readjust. In some cases, some people readjust in the way a spring does when a weight is removed – it springs back into shape. For others the spring will get back to normal provided the weight is removed gradually. For some others, the spring will not readjust.

      Some antidepressants appear to cause more problems than others but we do not know why this is. Fluoxetine may be helpful for some people as it makes the readjustment process more gradual but it is not helpful for all and comes with its own problems.

      There are a number other possibilities, one of which is that problems are more likely with potent serotonin reuptake inhibitors such as paroxetine and venlafaxine, in which case the best strategy is to move to low potency serotonin reuptake inhibitor.

      Managing Tardive Dysthymia

      It is particularly important for patients suffering from this condition to have a name for the state and an explanation for what is happening.

      For this reason it is proposed to name the enduring condition that can happen after discontinuation of an antidepressant tardive dysthymia. It is not clear how great the overlap might be between the tardive dysthymia linked to antidepressant, antipsychotic or benzodiazepine withdrawals.

      That a number of people exposed to antipsychotics, benzodiazepines or antidepressants may have an enduring problem has been recognized for some decades. The risks of having an enduring problem appear slightly greater for women, and may increase with age.

      There is no clear understanding of what happens in the brain to trigger such problems but it may be that with extended exposure to an antidepressant, some sensitive individuals lose receptors from the ends of their nerve terminals as part of an adaptive mechanism and when the drug is removed these receptors do not simply return to normal.

      If the explanation offered above is even partly correct, it implies that with time the condition should resolve but this resolution may take months or years. It would seem intuitively sensible to suggest that activity, which helps to refashion nerve endings, would help and those affected should therefore be encouraged to be physically active and in general to live life as fully as possible and avoid shutting down or withdrawing from activities.

      Activities such as walking or swimming may be helpful especially if undertaken in a graded programme that ensures there is daily activity and over time builds the activity levels up.

    5. Okay, so basically we’re on the same page. THANK YOU for sharing that letter on the blog! It’s a wealth of information and finally someone in the know is admitting it can be long term even after the offending agent has been removed, this simple fact is so often denied by most physicians.

      I think this sharing process is imperative in helping people find their own proper healing solution. So thanks again John.

      His final comment on staying physically active is so very important, I know for me, it was my saving grace. I suffered HORRIBLY for 4 straight months, unable to eat, sleep, sit still or leave the house, finally I started forcing myself out for vigorous walks, only then did I begin to slowly heal. It took me two more months before I saw a glimmer of light, but it came. I just want to remind everyone of the importance of avoiding sugars, alcohol, carbs, additional meds and really detoxing the body in every way possible, exercise being one of the most important components. Lots of water, fresh produce and lean proteins. Detox baths with sea salt, meditation, hypnosis, acupuncture, massage…do and get whatever help you can to help your body heal and come back into balance.

      All my best,
      Angie

    6. I just wanted to add a correction on my part. This reply was from Dr. Peter Breggin. He has a website where he sells books and has lots of info on the topic. Also on the site are archived radio broadcasts which you can listen to free. http://www.drpeterbreggin.com.

    7. Wow John! Dr. Breggin’s site is amazing! It’s great to see a professional in the field fighting for consumer health and safety. Thanks again for sharing.

    8. I also wonder if there a PTSD factor involved in all of this. It may also be that after the akathisia/withdrawals are over, the PTSD takes over and gives an illusion that it’s still there.

    9. The only thing is, I’ve suffered anxiety, panic attacks and Akathisia, all at different times in my life. And they feel very distinctly different. Though yes, maybe someone who hasn’t felt any of those feelings before may slide from one phenomenon to another without being able to discern the difference. I guess it is possible. But even after I really felt back to myself after the Akathisia, I did have intermittent anxiety and panic the following year. I didn’t necessarily correlate the two, but now that a couple years have passed, I think it’s possible the one directly precipitated the other.

      But then, as devil’s advocate, if what followed was indeed more standard anxiety then it would be easily alleviated with a basic anxiety med, but the people I have heard from don’t get any relief from meds. That makes me pretty sure it’s still Akathisia, because that’s the only mental condition I’ve ever experienced that meds couldn’t touch.

      Good food for thought…

  35. Hello,
    I was on haldol for three years when I developed akathesia. I have stopped the medicine but the akathesia still persists. I tried benadryl and it reduced the anxiety. I am so scared that this will last forever. Is this tardive akathesia? I read that tardive akathesia lasts about three years! I don’t think I can take it for that long! Thank you so much for your help!

  36. Hi. About 5 years ago I was prescribed Effexor 75mg for mild GAD. It seemed to work ok, but I was never really that bad to begin with. To make a long story (sort of) short, in July of 2010, I quit the effexor cold turkey. Shortly after I began having panic attacks which I now know was from withdrawals, and also head zaps. These seemed to of disappeared in August 2010. Then in September of 2010, I had a hair transplant. Minor surgery, but was given large doses of Keflex, and had local anasthesia injected that contained adrenaline to prevent excess bleeding. This made my heart race, but its a normal side effect. This is a second procedure that I had with the first being 2 years before this one. 2 days after the procedure, I was sitting at home and all of a sudden starting feeling a feeling I never in my life had before. I Although I had panic attacks from the Effexor withdrawals, these feelings were different. They felt like feeling of doom, dread, and all thoughts good or bad seemed to be amplified by 100 fold. I would be breaking out in sweats, then alternate with being freezing cold. My neck was streaked with a flushed red color, my eyelid constantly twitched, and my appetite disappeared. I lost about 25lbs in a few weeks. My mouth was constantly dry, and although I have perfect eyesight, it looked as if I was looking through a sheer veil. I would usually wake in the morning being ok, yet within a few minutes begin the cycle all over again. At work to subconciously run from the feeling, I would constantly be moving; I would walk around the block, move about the building all day, and avoid the lunchroom so I didnt have to sit in one place. I went to a psyciatrist for the first time, and he didnt act as though anything was odd. He tried to prescribe me ssris and xanax. I refused it and started going to a holistic therapist which was useless. At this point it was December of 2010. I caved in and saw another psyciatrist who prescribed me Effexor 75mg. I took this for about 3 1/2 months while seeing a psycologist who diagnosed my with anxiety NOS, and still had no relief. Then come April 2011, and I started to sporatically feel better. Not great, but I did notice improvement. My appetite returned, and I began regaining the weight I had lost, and began enjoying things once again. In June of 2011, I discontinued the psycologist, who said that it couldnt of been the Effexor giving relief since I would of seen improvement much earlier than 3 1/2 months. As the summer months of went on, I continued to improve, with many small bouts of “spells”; some larger than others. Now its Oct/Nov/Dec 2011. There are times where the feelings were completely gone for days, sometimes for weeks at a time. Christmas came and went, then the day before news years eve came and I regressed back to the way I felt many months ago. I seems like all my recovery has been thrown out the window, as many of the symptoms that have gone in the past few months have come back. Thank you for reading this, as this has been a very long post. Any insights on what this can be? And what do you think has happened? I would like to add that im still on the Effexor, and am not taking any other meds or have ever done so.

    1. John,

      I’m sorry it took me so long to reply..I couldn’t get into my WordPress account. I finally worked it out so here I am. I have published your post, but I will reply via email. Please update your condition here on the blog as things improve so others who suffer akathisia can learn of things that do and don’t help.

      Talk with you soon,
      Angie

    2. Slightly, but overall within the last few weeks it took a major drop, although i’m still on the effexor, but weaning very slowly over the course of the next 16 months.

    3. I just had surgery two weeks ago. I was given a tumescent anesthesia (lidocaine, epi, and bicarb). I also am on high doses of Keflex I cannot sleep tonight and I am experiencing restless legs. I am a Registered Nurse and I am very well aware of anti-psychotics and anti-emetics causing akasthisias. I never before reading your blog know and antibiotics could cause this. I have already taken the benadryl and feel better a little. thanks for your help.

    4. Heather,
      I’m sorry to hear you’re suffering with Akathisia. It must be extra difficult because you know meds so well and probably feel like you could have avoided it. Either way, I’m really glad you’ve found help with Benadryl. I highly recommend you do the basic stuff like cutting unnecessary external stimulation, cutting or removing sugar from your diet for now, take Calm (cal-mag) and relax as best you can. It’s really all about relaxing and detoxing to allow your body to get back to homeostasis. I wish you all the best and please keep us posted, either privately or postings for the board for all to read and learn from.
      I wish you all the best in your recovery!
      Angie

    5. Hello John
      My name is Karen & I live in London.
      I’m very interested to find out how you are now since your akathisia started up again in dec 2012?
      Mine started on jan 1st 2014 & the only slight relief I have had has been from some paxil but am unsure if the akathisia will come back after stopping this med & how you got on with the effexor?
      Did you stay on it or come off of it & how did it help or not help your akathisia?
      I’m very aware that paxil can cause akathisia but I simply would not be alive now if I hadn’t started it 7 weeks ago.
      Many thanks
      Karen

    6. Karen, funny you should ask, because I’ve been tapering off of effexor since then, and every time I would drop, I’d feel random symptoms such as panicky attacks, dizziness, lightheadedness, etc. I really didn’t wait to reduce, and kept dropping, although slowly. In January of this year, I again crashed, and would up just as bad as in 2010. I just now began to slightly improve a bit, so hopefully it won’t take 8 months to get better like it did 3 years ago, since I didn’t go cold turkey. By the way, I forgot that post I wrote in 2012 how it was returning. Since then it got better to a point where I forgot all about it, and was only getting other symptoms from the tapering.

    7. Hi again John.
      Thanks so much for your reply!!!
      I’m a tiny bit confused about wether your saying that In jan this year you went bk to how you felt in 2010 with your withdrawal symptoms of with the akathisia?
      And also- do you mean that the akathisia symptoms have all gone now since 2012 & the panicky symotoms you experience now & again recently are just from tapering or do you mean that it feels like the same akathisia type of feelings?
      Thank you so much John.
      I hope doing ok.
      Karen

  37. Many years ago I took Prozac for a month to see if it would help my IBS. It didn’t, so I stopped taking it. 6 months ago I started to have severe anxiety and depression and was prescribed Prozac again. I avoided taking it for many months as I felt afraid of being on it long term. A month ago my whole world was shattered and I started taking the Prozac. I took it for 3/4 days and at the same time everyday I became very agitated and felt like I could lose my mind. It was so bad that I considered going to a psychiatric unit. I went to see my GP and she prescribed Citalipram. I took it for 1/2 nights but I had the same problem, so I stopped taking that, too. I took Inderol for a few days but it made me so incredibly tired and caused me to feel so distant from the world, plus it gave me an upset stomach.I had been FINE with Prozac the first time I took it, several years ago. The only side effects I had were interrupted sleep but aside from that, it was great and it made me more relaxed and confident – but I was taking it as someone who was NOT suffering from depression. This time around, the side effects have been terrible. I THINK that I am suffering from depression and I definitely have major anxiety problems but I am now scared to take any medication. I don’t know what to do. Sometimes I feel I can’t carry on with everyday life without help. Kate

    1. Kate,
      I’m really sorry to hear what you’ve been through. As all of us here know, psych meds aren’t anything to be taken lightly. I’m not sure if what you’re experiencing now is indeed still Akathisia, but I think your post is important. I had taken Compazine several times before, when I was younger too. But that last time they gave it to me, for whatever reason, my brain wasn’t able to cope with it and it threw me into a catastrophic, unrelenting, 5 month bout of Akathisia. Our experiences just show that our brain chemistry is always changing and shifting and what works at one point in our lives may not work at other times, and may even be detrimental.

      This just furthers the argument for being VERY CAREFUL about taking meds, even ones we think are ‘safe’.

      I will answer your post in more detail in private, so check for my email shortly.

      All my best to everyone out there who is looking to be more proactive in their own health care.
      Angie

  38. Thank you so much. I was nearly going out of my mind watching my son suffer and not knowing what to do or how to help. I can only imagine the fear and frustration he must be feeling. We/he is on his way to recovery but it is very under stated information. Thank you again for taking the time to gather and share this site.

    1. You’re very welcome. I always LOVE hearing about recoveries. And if there is anything in particular you have implemented to help him heal I’m sure everyone would be interested to hear what/how you’ve gone about it. Thank YOU. : )

  39. Hi Angie been long time not on here. Its not the akathisia that has caused my abnormality in the brain but the severe reaction to maxolon and then cogentin that they tried to treat the reaction with caused this abnormality that is going downhill over past 6 years. I am not getting any better neuro says its very serious no cure. I still continue to have episodes of akathisia.

  40. I was given a nausea med by IV at my monthly infusions. I noticed I couldn’t sit still (akathisia) and was having painful leg spasms. I finally begged the staff nurses to please do something. They told me it was the nausea med (in the Thorazine family) and it sometimes caused these symptoms. I started shaking and they had to administer Ativan by IV to halt the sensations.I now have this drug on my Allergy List in my ER Information card and at all doctors offices.No one even asked me if I might have a problem receiving a major nausea med like this and I was horrified to be in such pain with drug induced Akathisia.Imagine trying to walk off leg spasms when attached to an IV pump””

    I was glad I was in the position to ask what in the world was happening to me.How many others have had this happen and didn’t realize it was due to the drug?? This should not be a drug so casually given either by IV or pill to anyone.

  41. I came out of anesthesia, with severe akathisia.Hi my name is Anne, I am 43yrs old, 2 mos ago..I didn’t know what was happening to me and the nurse anesthetist didn’t believe me when I said that something was very wrong. I left the hospital and paced for 3 days 4 nights thinking that I was going to die. I ended up in the ER and given IV ativan. The symptomes were so bad that I couldn’t work and was eventually hospitalized..a neurologist diagnosed me with akathisia. I am a single mom of 3 and I am about to lose everything if I don’t get some relief from these sx. Ativan helps but not like it used to, I have also tried klonopin, inderal with no relief. There is no one to help me through this. At its worst I pace non stop trying not to call anyone until an atvan kicks in because I can’t afford to be written off as crazy and sent to the looney bin. Medication did this to me over 2 mos ago. I was off work without pay and so terror stricten that I would/will lose my children and home. I have been back to work for 1 wk..sx were so bad today that I fear losing my job…if that happens..it’s all over for me and my children. I am desparate for help..I will go anywhere for help…does anyone know of an expert?

    1. Anne, if you are like me, then Ativan is part of your problem. It can have a rebound effect which is a double-edged sword. I only take it as an absolute last-resort, because the next day at the same time I took it the previous day, I will all of a sudden have a bout of intense anxiety even worse than the day before. The only way I’ve found to stop it is to stop taking ativan. It is a benzo, and they are notorious for causing terrible withdrawl symptoms. The bad news is, if this is your problem then you need to stop the ativan. The good news is, once you get it out of your system, you’ll again feel strong & capable and the anxiety will not stay constantly anymore. I can tell you that it is worth it, getting away from the ativan. But I recommend you research about tapering off benzopines, and do it the safest & least bothersome way for you. It depends on how much you take as to how you can safely stop taking it, or you risk creating a bigger problem. A knowledgeable physician is helpful, or at the very least one who is receptive to educating themselves when they aren’t familiar with a patient’s condition.

      Wish you the best. I know how frightening it is to be in your position, and that you can & will make it through this ok–don’t give up!

  42. I started abilify about 5 weeks ago and almost from the onset have been feeling restless, agitated, frustrated, like I want to jump out of my skin. I’ve been off for almost 2 weeks and still feel this way. How long should I expect to feel this way? I am also on Luvox, but have used that and other SSRI in the past without this awful feeling, so I’m thinking its the abilify. My doctor wanted me to try Topamax–no thank you. I dont know what to do, I feel AWFUL! 😦

    1. Julie,

      Sorry to hear you’re still having trouble. It often takes longer than the doctors or pharma companies will admit for the dopamine/serotonin balance to get back in order once you’ve stopped taking the offending drug. From what I’ve learned there is no rhyme or reason to how long it takes each person, depends more on your own body chemistry and stress levels, etc. It could take another week or even month or so. I had two doses of Compazine and it lasted a few months for me and then an additional 2 months, on and off, until I was totally back to normal. So just know this is a possibility, but also know that IT WILL GO AWAY. The more accepting and relaxed you can be the better you will feel.

      As far as Topamax. I really don’t know why he would prescribe this for Akathisia, but I’m certainly not a doctor, so maybe he knows something we don’t know. I DO know that propranolol is often used to counter Akathisia. Topamax and propranolol are both migraine treatment meds, but they are totally different as far as ingredients and how they work. Propranolol is a beta blocker and from what I know, a lot less chance of crazy side effects. So maybe you want to ask him about this instead.

      Please read through my recommendations at the end of the blog for relief. Don’t underestimate the power of simple things like drinking plenty of fluids, a multi-vitamin, vitamin B’s. Also, you can try Natural Vitality, Natural Calm..it’s a magnesium powder and can help greatly with agitation and anxiety.

      I also want to put a resource out there I don’t think I put in the blog and it’s http://www.askapatient.com. It’s a website that allows you to input the name of the drugs you are taking and see how some people have reacted to it in the past. Just keep in mind, most people who are going to bother to post about a drug are generally people like you and I who have had a more severe reaction. So don’t let it freak you out too much, but it’s good to at least be informed and can help you not feel so alone while you’re going through this.

      I wish you a speedy recovery and if you have any more questions or just need to vent or need someone to give you some moral support feel free to write again. You are not alone in this and you WILL feel back to normal again soon. Keep that in mind.

      All my best,
      Angie

    2. I’ve heard of Abilify causing Akathisia for quite a few people. It is all over the net. I’ll make sure to sneer at the next Abilify tv commercial, in your honor 😉

      Topamax is sometimes used as a mood stabilizer, which may be why it was prescribed for you for the anxiety of akathisia-but it would be nice for you to get the direct answer from your doctor so you’ll have that info.

      I take regular (NOT long-acting) Inderal / propranolol 40 mg tablets 3 times each day, and .5 mg Ropinerole 3xday if needed. That is what controls my akathisia symptoms. I also take 6mg of Melatonin each night, to help ease sleep. I am always woken up by akathisia. I have had it for a year, after taking the antibiotic Cipro. One source I’ve read claims that the only way to get it to go away completely is to stop the meds which cause it , including treatment specifically for akathisia. I’m trying to decide now if it is worth the risk of it not helping & going through all that torture for nothing, by stopping everything. I want off this nightmare rollercoaster. *Angie, what do you think? Have you heard this, also? (Angie is the owner/moderator of this great forum, and screens all posts)

      This site has the most helpful & comprehensive info for akathisia that I have found on the net. Definitely bookmark it, and read up on things that can help you control these symptoms better. For one thing, it helps a great deal to get off any artificial stimulators such as caffeine, and avoid upsetting situations that cause your adrenaline to spike. (Good luck on that one)
      If you have any questions, many people have subscribed to getting notified when there are new postings, and will return to answer you.
      I wish you a speedy recovery!

    3. Cyndi,
      I know from all I’ve studied that getting the body as clean as possible makes the best foundation for getting the dopamine/seratonin back in balance. So I’d have to agree that the less meds you take, the better your odds are of ridding yourself of Akathisia. Though I have to say that for me benzos (ie – Xanax/Valium) did help take the edge off while I was still suffering through. Everyone is different though and some people do react poorly to them. But I’d say if you have taken them with no issues in the past it’s probably safe to do so while dealing with Akathisia.

      The withdrawal effect of benzos isn’t a dangerous situation after short-term use. When it becomes seriously dangerous is when someone has been on regular doses for many months or years. I’d hate for people suffering through Akathisia to be worried about that issue as well when it’s really not a threat in the short term. The only issue with medicating symptoms of Akathisia with benzos is the risk of getting dependent on them, even if just mentally. So I too agree that once the Akathisia start becoming manageable and letting up that one would, with the help of a knowledgable and CARING physician, begin to ween off of the drug slowly and safely.

      There’s so much to know about how all this works and again, I’m not a doctor. But we have to stay AWARE as consumers and patients and help each other when possible. I really appreciate all the comments, in hopes that people searching for info can get something out of what others have been through. Thank you all so much for contributing.

      With love,
      Angie

  43. Hello,

    My name is Cyndi. The only medication change I had was taking Cipro, an antibiotic. You can google online for the words ‘akathisia cipro’ and find the medical article that discloses that Cipro, Levaquin & other antibiotics can cause akathisia, also.

    My case has been with the terror and sense of doom, which is truly intolerable. It is like mental torture that one cannot escape from, because it is within You. It is truly indescribable how horrible it is. Nothing feels safe, and I also get the restless feeling/have to move. Sleep is impossible with these dark feelings & fears. It helps to remind myself that this is physiological, and not ‘real.’

    I’ve learned that anything that causes an adrenaline rush will bring on the symptoms like gangbusters. An argument, a scary movie, caffeine, Red Bull type drinks…any type of stimulant makes it much worse.

    I am very anemic, and my doctor prescribed extra iron for me. He thinks this may be aggravating the akathisia, which he calls “restless legs.” For some reason, he won’t acknowledge this as true akathisia. However, I’ve had this happen to be before, coming off other medications & also one time with Compazine, for nausea after minor surgery. I was still under the affects of the anesthesia and couldn’t keep my eyes open, but was pacing my hospital room endlessly. Benadryl helped that time, but not this time. This time, the only thing that helps is .5 mg of Ropinerole (for restless legs) 3 times a day; and the Inderal/Propranolol 40 mg 3 times a day.

    By the way, people may want to research Propranolol and discuss it with their doctor if this is the med they want to try, because I found out that for me, the extended release capsules were *not* helpful, but the regular tablets are more effective for akathisia.

    Lastly, I wanted to suggest that you add a section advising people with akathisia to think about making an allergy alert card for their wallet, saying they are allergic to the medications that cause the akathisia for them. Do not rely on just your chart allergy info @ your doctor’s office…people need to really get that info out there for others to see, in the event of an emergency.

    For myself, I add all the meds that could trigger akathisia, because I don’t ever want to have this triggered again. This is what my card says:

    ALLERGIES: Compazine, Reglan, SSRI’s, Neuroleptics (anti-psychotic meds), Fluroquinolones (Cipro, Levaquin)–cause Akathisia with inability to stop moving and extreme anxiety & panic. I Do Not want any meds that can cause this condition; if given in error, please give remedy ASAP, even if I’m unconscious.

    –I am a nurse, and although I am not giving medical advice to anyone, I can tell you after working as a nurse that the medical profession does pay attention to your Allergies List. They are liable if they ignore it, and it is an important part of their training. Also, it isn’t easy to remember all the meds that can trigger akathisia, so having it written out & available for you to get out of your wallet when needed for reference is very helpful.

    I plan to update my allergy medication with my doctor’s office & keep this medical alert card in my wallet, which I highlighted in red ink and laminated. I also keep reminding my family members how important it is for them to be pro-active about protecting me if the doctors will not take akathisia seriously. This helps me feel better prepared for an emergency. I wanted to share that with others who suffer from this condition, hoping they will safeguard themselves, also.

    By the way, I’ve had akathisia for over 6 months now, and wish I could say it was gone. I still have to take Inderal and Ropinerole, although sometimes I don’t have to take as much. Right now, I take Inderal (propranolol) 40 mg. tablets 3 times a day, and .5 mg Ropinerole 3 times a day, sometimes less. I also have been on B-Complex & B-12 vitamins & B-6 for about 4 months. It is better, but it is “still there.” If you have had akathisia, then you know what I mean by that comment. It is a sensation one feels, and the intensity of this sensation is less than what it was 6 months ago, thank goodness. But I pray it will go away entirely. I’m really worried that I will have it forever.

    Thank you for this site, it is nice to be able to talk about this with others who understand, and try to help with my story & suggestions. Good luck to everyone, I wish you all renewed health & peace of mind.

    -Cyndi-

    1. Hi cyndi I now it’s been a few years but if you get this did your akathesia clear up and if so how did it get better for you

  44. I was on celexa for 6 yrs and lexapro for 2 when I went off lexapro one month later akathisia hit hard and has been ongoing for 14 months My life has completely changed I don’t work I don’t sleep I cry all the time,benadry is bad news for me, inderal doesn’t work all that well either. What can I do? I think it may be permanant. help!

    1. I’m so sorry to hear what you’ve been through 😦 I’m not a doctor, so I can’t recommend treatment, but in the bottom portion of the blog gives some advice. Have you seen a doctor about this? Have you tried an alternative healer who works with herbs/acupuncture, etc? Also, something that helped me get over it, which I may not have listed in the blog is progesterone cream we got at the nutrition store, no prescription needed. Use it as recommended on the jar. It’s most important to get just one good healthcare professional to work with you. I had a chiropractor who understood herbs and used to be a pharmacist give me the progesterone cream recommendation and also talked me through some rough times. He was also willing to see and treat me, but I couldn’t tolerate going ANYWHERE when I was going through it, so that wasn’t an option for me. But that would be a great thing to do if you can at least tolerate getting out and about, at least just for an appt. If you want to talk I’m certainly here, just let me know if you want me to email you and I will. You are in my prayers and if there’s any way I can help you find appropriate resources in your area I absolutely will.

      Warmest regards,
      Angie

  45. hi ive developed this condition severely on 10mg of abilify,so i broke the tabs in half and its not quite as bad still have panic and insomnia but not quite as restless.kind regards timmo

  46. I am terrified and at war with thoughts of suicide which appear to be the only way to end this torture. I have two dogs, and they are the only reason i do not find a way to obtain a gun and blow my head off. I am certain that I have akathisia and that i have had it for a LONG time and i always thought i was truly nuts, something was inherently wrong with me, on and on, i should just stop wasting space and kill myself out of pure decency to the world. Haldol among other drugs i was on for many years since age 10. I had anorexia and got institutionalized and treated like garbage or a queer specimen for a long time. Since highschool it has been an endless list of medications, all of which, i have discovered on my own, can cause akasthesia. I am so frightened that no doctor will listen to me or help me, because they never have. My therapist will listen to me, but she is out of work for a few weeks. I feel like i’m running out of time, I am holding on for my dogs who are my heart. This needs to end. Health care proffesionals need to be more aware and informed of akathisia. I am glad there are people out there who are understanding of this torture and trying to spread awareness and provide support, it gives me some hope of fighting this. It is a fight for my life. I am so scared my doctor won’t take this seriously. I am too worn out to find a doctor who will help. It has been too much. I don’t want to commit suicide. I don’t. Thank you. I am sorry.

  47. I hate to tell you this i had my reaction and very severe one 5 years ago to maxolon i still have akathisia some days worse than others it is terrible and very driving and internal torture exhausting feel like i goning to climb the walls nothing seems to help and i find even taking panadolfor pain makes it worse. They have now found a serious abnormality in the brain i truly believe this has been caused by this drug reaction i can say i have never been right since this have lots of other symptoms but a doctor told me in a whispher you will never get a doctor to admit this even if he thinks it is right i could loose my job telling you this. This doctor wa vey good to me help me where he wa able and open minded.

    1. Sassy,
      I’m so sorry to hear this 😦 I too have yet to get totally back to normal, but I wouldn’t say I’m suffering at that level such as you describe. I’m hoping you have days of reprieve? Is it improving as time goes on? Also, I’d love to hear what you’ve tried to help your brain get back into balance. If you would be comfortable sharing a little more info I think it would be a great help to others.

      Yes, with the doctors, certainly they all work basically for generous kick-backs from big daddy pharma, so getting them to admit to this phenomenon is like asking a child to rat out their dad, right? Not gonna happen. Most act ignorant as if they have no idea what the work Akathisia even is, I think that’s a load of crap. I think they know very well.

      So I guess the last thing I want to say is,, be SURE to take your multi-vitamins and B vits. So important in helping your brain chemistry even out. But you say they’ve found an actual physiological abnormality within your brain? And you believe this was caused by the Akathisia? I’m a little confused..Please do share if you feel comfortable doing so…

      I wish you all the best!
      Angie

  48. I experienced similar side effects when I started taking 80 mg/day of Zocor- a statin. It was intense and crazy, but went away after a couple weeks. Only months later did I read that this can be a side effect of cholesterol lowering drugs. Doctors don’t tell you!

    1. Wow! I actually wasn’t aware that medications for cholesterol could also have such effects. Thank you so much for adding the comment, this will definitely be helpful to others in the future. The more we help educate each other, the better off we will all be. I think being proactive in your own health care program is very important. Thanks again!

  49. Thank you so much for your advice. I really appreciate it. One more question – I have looked into the half life of Prozac and it seems that the drug will have definitely left my system after 5 weeks of stopping it. Do you think it would be safe to then start taking, at a low dose, 50 mg per day, 5-HTP? I live in Spain and unfortunately, my particular doctor refuses to even believe that Akathisia exists! So, I am unable to get professional medical advice. I feel that I suffer naturally from low levels of serotonin (apparently common amongst addicts and alcoholics) and would love to find a safe anti-depressant to take. The prozac worked wonders before the dreadful episode of Akathisia! Many thanks again.

    1. I’m not a doctor, I’m just someone who has been through it as well. I really can’t give you medical advice. I understand the doctors not being willing to acknowledge the prevalence or severity of Akathisia. Can you see a different doctor? Actually neurologists and psychiatrists are most aware and knowledgeable about Akathisia, so you may want to go that route. There are some doctors that do get it, try and find one who does to help you while you’re going through this.

      From what I’ve learned about Akathisia – It’s not a matter of when the drug leaves your system, it’s that it threw your own brain chemistry out of whack and recovery is different for everyone. Some people get back in balance before the drugs are even clear from their system, while for others it lingers on well beyond the half life.

      If you have chronic depression I would definitely consider finding a CARING counselor/therapist, someone who is willing to acknowledge what you’re going through and willing to help you work through the depression. Depression doesn’t have to be a permanent fixture in your life! Cognitive behavioral therapy, as well as other forms of psychotherapy can get you back on track and feeling much better. Please consider looking in to this, K?

      I don’t know if 5-HTP would be a good option for you simply because your brain is obviously prone to getting unbalanced fairly easily. I really would recommend the vitamins, I know it sounds benign, but they can work wonders, esp the vitamin Bs. Maybe you have an alternative/holistic practitioner in your area? This type of practitioner is in to healthy and natural healing modalities; they often use natural supplements and vitamins, massage, acupressure/acupuncture and other non-invasive ways to help regulate your body.

      There’s no need for you to figure this out all on your own. Talk to people you know about it, someone you know may just know someone that can be of help to you. Look around for a doctor and a a holistic practitioner to assist you. And def consider therapy. These are all great ways to be proactive and get yourself on a path to TRUE healing.

      I wish you the best! Let me know what you find and how you’re doing…

  50. Hi,

    I suffered a terrible bout of Akathisia after being on Prozac, 40mg a day, for 2 months. I then had another attack a week later, as I halved the dose in a bid to stop the medication. I then felt so lousy and depressed, I started taking 5-HTP as a natural alternative to the prozac. After only 2 tablets I had another bout of Akathisia. This was a week and a half ago. All I am taking now is Valerian, in order to reduce my anxiety and try to sleep (I suffer from awful insomnia). My question is, am I destined to always be hyper sensitive to serotonin and be prone to Akathisia? I feel thoroughly depressed and desperately would like an alternative something to take in order to feel better. I am a recovering addict and cannot take addictive mind altering medication, such as diazepam. I would really appreciate any advice! Many thanks.

    1. Fiona,

      I’m sorry you’re having such a hard time with this. It can feel like you’re stuck in hell, but it’s not permanent. Long term Akathisia (Tardive Akathisia) generally only happens after a person has been on the offending medication for a very, very long time. It may take you a few weeks to get back on track, but you will recover.

      Be sure to take good care of your body, drink plenty of water, use relaxation techniques, get some light exercise and take a multi-vitamin and vitamin B supplements. Vit B6 and B12 are most important. Fish oil supplements have also been proven to be very helpful with getting the brain back in balance. These are mild, yet effective supplements so you can feel safe taking them.

      The dopamine-seratonin balance in your brain is a fine balance and they both affect one another, which is why it can be tricky to try and use other meds to combat the imbalance that Akathisia causes. That’s probably why the 5-HTP only made things worse. If you’re going to try any med I’d recommend either Benadryl or Propranolol. They’ve been reported to be the mildest and yet most effective medical treatments for the anxiety associated with Akathisia. You want to make sure you talk with your doctor about it if you want to try the Propranolol and do it under their supervision, starting with a very low dose to see how it affects you. Basically the Propranolol dampens the fight/flight anxious feelings in the nervous system, but if you are suffering mostly with depression it may not be a good idea because it can lower your mood only adding to the depressed feelings. Do some research on it and make an educated decision.

      Smile a lot. Even if you don’t feel like it, smiling has been proven to release the good mood chemicals in the brain. You don’t need to understand how it works, just that it does. So smile, talk and laugh with friends, think positive thoughts about how you will be feeling great soon and that you WILL heal.

      For the anxiety and insomnia I used a hypnosis recording I found at the itunes store. It’s called – Relieve Anxiety with Medical Hypnosis by Steven Gurgevich. You might want to try that or something similar. Don’t stress too much about the insomnia, worrying about it will only add to your anxiety. Just know that soon enough you’ll be sleeping normally again and then you will be able to catch up on the sleep you’ve missed out on.

      Most important is to keep the faith that you are going to get through this, even if it doesn’t feel that way right now. Take care of your body like eating regularly, drinking plenty of water and getting some exercise and try the relaxation techniques such as meditation and hypnosis.

      I wish you a speedy recovery!

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