Akathisia is a psychiatric medication side effect that revolves around psychological and psychical restlessness which causes distress. People with bipolar disorder report more akathisia with psych med treatment than do those with schizophrenia. And I am now reporting the horrible restlessness, agitation and distress of akathisia is happening to me.
What Is Akathisia?
Akathisia, according to Google, is, “a state of agitation, distress, and restlessness that is an occasional side-effect of antipsychotic and antidepressant drugs.”
Or, according to the American Heritage Stedman’s Medical Dictionary is:
- Motor restlessness characterized by muscular quivering and the inability to sit still, often a result of chronic ingestion of neuroleptic drugs.
- Intense anxiety at the thought of sitting down; inability to sit down.
What Causes Akathisia and Inner Restlessness?
As both definitions say, it’s typically a side effect of psychiatric medications – generally antipsychotics, which are commonly prescribed for bipolar disorder.
And, by the way, “occasional side effect” is entirely incorrect. According to this study, almost one-in-five people who take aripiprazole get akathisia. I would not call that “occasional.” (And, seriously Google, there is no hyphen in “side effect.”)
The above definitions, by the way, are pretty much identical to the definitions for psychomotor agitation, which is an actual symptom of depression in bipolar disorder.
When akathisia is reported as a psych med side effect it is determined to typically be mild-to-moderate and rarely is why people choose to stop taking a medication.
What Does Bipolar Psych Med Side Effect Akathisia Feel Like?
The simplest way of describing it is just an incontrovertible drive to keep moving. For me, this means clenching and unclenching muscles – usually in my legs. This need to move feels like an instinct – something built-in that you can’t stop or overcome.
If I stop moving, there is, what feels like, a pain underneath my skin. It’s like there’s an electrical current running just beneath my skin that magically goes away when I move. Really, it’s the oddest thing.
And, yes, there is psychological agitation and distress as well. The psychological agitation takes the form of I-just-want-to-rip-someone’s-head-off (not out of anger but agitation) and the distress comes from feeling this way, not being able to relieve this feeling and, of course, the physical aspects as well.
When I’m really focused on something it’s not that bad, but if I lie down to rest, for example, and try to calm my muscles and brain, that is when it becomes more intense and problematic.
It also occurs to me, now that the akathisia is pronounced, I’ve been experiencing it for a long, long time it just wasn’t bad enough for me to put two and two together.
Handling the Bipolar Psych Med Side Effect of Akathisia
Like I said, for me, clenching muscles works to relieve the sensation. I clench my right leg and then my left and so on, sometimes in a rhythm correlating to a song stuck in my head (an earworm).
However, my understanding is that for other people, exercise works well. If you wear out the muscles, they should stop wanting to move? I’ve tried this, and while exercise does remove the urge while you are actually exercising (presumably because you are using your muscles) it doesn’t seem to help beyond that. People vary on this, I’m sure.
Also, in a crazy turn of science, low doses of antipsychotic (yes, the very thing causing the akathisia) seem to actually treat akathisia. What can I tell you, psychotropic medications are weird.
If you’re experiencing psychomotor agitation as part of bipolar disorder or akathisia as a medication side effect, remember to tell your doctor. He or she may be able to help you with medication or suggest coping techniques. In my case, this particular side effect seems to be calming a bit as I’ve been on the medication combination long enough now. Hopefully others experience this calming over time as well.
[References for the above linked inline.]
Image by Gumy-11100 (The Young and the Restless serial) [GFDL or CC BY-SA 3.0], via Wikimedia Commons.
Banner image by Flickr user Alex Lomas.
I’ve experienced akathisia with just a few medications, of course all antipsychotics. I got it almost immediately after starting Zyprexa and then later Abilify. With those meds I had the “can’t sit down, must walk quickly all of the time” feeling. That was rough. They even gave me Cogentin to help the akathisia with Abilify, but I don’t remember it being perfectly helpful. With the rest of the antipsychotics I seemed akathisia-free, but of course had other side effects. I’ve been on Geodon and Seroquel XR for most of 7 years now. After about 4 years I started getting akathisia suddenly. My psychiatrist said it was the Geodon. I agree. With Geodon I had a little bit of the physical restlessness, but even more so the “psychological agitation and distress” that you described. I can lie in bed and my mind tortures me.
My psychiatrist told me to use the Ativan I was using prn for the akathisia. I think that was a big mistake. I’ve been taking at least 1 to 2 mg of Ativan every day for these 3+ years. Now I’m wondering if I’ll easily be able to go off of it. Now my psychiatrist decided to take me off Geodon since I’ve been well mood-wise for a while. He started to wean me off and I’d get brief reprieves from the akathisia, then it would come back. I’m still trying to be weaned off the Geodon. Now I’ve been in Geodon withdrawal and am stuck on 100 mg after having taken 160 mg for 7 years. Rough!
At one point my pdoc tried giving me Cogentin for the akathisia again. I had such horrible constipation from it that I couldn’t take it anymore. So hopefully my Geodon weaning will progress within a month or so. But I’m still taking Ativan every day.
I have recently started on Seroqual and are experiencing bad shaking and RLS. when I smoke, my cigarette falls out of my hands, and I cannot type on my cellphone.
I believe this is extrapyramidal symptoms.
What is the difference between extrapyramidal symptoms and akathesia?
My husband has had akathisia for the past 2.8 years.
We have a support group on Facebook “Living with Akathisia” if anyone needs support
Here is his youtube video explaining parts of Akathisia.
More people need to be made aware of this
I was given Geodon for mild mania, and what happened to me was beyond description, even though you guys are dong a pretty good job. I called it the “jumps” in a severe totally incapacitating way. I only took one dosage because I so disabled by the drug. I had a couple of sleeping pills and slept it off and never went near it again; I know what worlds for some does not work for others. This was the worst experience of my life. I am lucky I was not in a hospital, so i could just stop taking it and put myself to sleep. Woke up a couple hours later, and was thrilled that the condition was gone.
Aripiprazole’s side effect of akathisia nearly killed me. I had no idea what was happening, the doctor kept raising the dosage because they didn’t recognize that it was akathisia, and I ended up in the psych ward where they gave me Geodon on top of it, and caused worse akathisia. I would have jumped off the building and ended it if I could have. I somehow faked my way out of the hospital, left my doctor and found another one who recognized it right away and took me off both Abilify and Geodon. But I can tolerate Seroquel just fine…no akathisia. And it’s in the same class?
Hi Dec29,
Yes, they are all antipsychotics but I have found that antipsychotics all differ. This is particularly trip of aripiprazole as its mechanism of action is slightly different.
– Natasha Tracy
I suffered from a terrible inner restlessness while on Abilify too – I have been on many meds over the years but found Abilify especially difficult. I wanted to jump out of my skin. It went away within 2 weeks of stopping it. I know antipsychotics can have this effect, but I really found Abilify to be the worst drug I was ever prescribed. I’m glad you got straightened out – a lot of P-Docs remain clueless about the akathisia this med causes.
I have experienced restless leg syndrome as a result of taking Trazadone…which was ironically initially prescribed to treat insomnia. The symptom arose after several years of taking the drug, so it took some time to discover the cause of the RLS. Luckily my insomnia improved so I (with the approval of my psychiatrist)discontinued the drug and the RLS stopped within 3 days. I cannot imagine suffering from such symptoms daily…you have my sympathy.
You gambled with the lobotomy drugs and lost. Keep in mind, it gets worse. In fact, akathisisa causes a large number of suicides.
Hi Mr. Friendly,
It’s interesting that you would say that as a very major 2016 study says, “Psychomotor agitation and high-risk behavior were not significantly elevated before suicidal behavior.”.
Reference: http://www.ncbi.nlm.nih.gov/pubmed/27233466
It is known that severe anxiety is a risk factor, but that is a very different thing.
– Natasha Tracy
The best rebuttal to that I can think of is anecdotal, but I think it’s appropriate.
When I was diagnosed with having depression and ssris/snris/tricyclics didn’t help, I was stuck on neuroleptics. My issues with them were dismissed, downplayed, I was fed the familiar lies of “chemical imbalance”, the fallacious comparison to diabetes, and I was never told how to taper.
When I quit cold turkey? Withdrawals aplenty. The nuthouse quacks wouldn’t have it, and my actions were glibly dismissed as “bipoalr 2”, despite mania never occurring before or after I started the drugs and then quit them.
I stuck with those horribel quacks from age 14 to 26, starting with prozac and some medical speed for ADD, and when I finally put my foot down and decided I could suffer on my own, I was on Haldol, Lithium, and Klonopin. Because it seems psychiatrists suffer from the most horrific form of anosognosia.
I had tardive finger movements, looked like I was playing an invisible guitar with my left hand. What was I told? Oh no, the drugs are safe, you have aspergers!
I’m miserable and feel half dead all the time, but I felt the same on those horrible drugs. But at least I’m no longer 250 lbs, can think straight, and no longer have high blood pressure.
My life is a living hell, a drawn out torture, but I know the second I step in front of one of those unethical pushers, I’ll be stuck back on a rainbow of horrific lobotomy drugs. It seems the end result of psychiatry isn’t improvement, well being, but merely keeping the loonies doped up, quiet, and working.
Hi Mr. Friendly,
I’m sorry you’ve experienced such a hard time. I’m sure that’s very difficult. But, as I always say, anecdotes are not evidence of any sort.
– Natasha Tracy
It was my fault for making the mistake of ever trusting a psychiatrist.
Akathesia is ridiculously frequently misdiagnosed as acute anxiety particularly once it is severe. The only way to distinguish is to take them off the drugs and see how they respond
It’s that same kind of flawed assumption that keeps so many psychiatrists from accepting that medications cuase severe, unpredictable withdrawals. The effects of them are just dismissed as the original illness coming back. Same reason that they refused to admit benzodiazepines were addictive.
No they know they are addictive. Even read some interesting analysis stating they were at this point the most addictive known substance on the plant with physical dependence forming in under 72 hours.
About 3 years ago they discovered the mechanism of addiction.
It is why they dont refer to it as addiction. They dont want people freaking out and suddenly stopping it and suiciding from the agony of it. So instead they call it antidepressant discontinuation syndrome.
Hello Margaret,
I’d like to clear up that antidepressants are _not_ addictive. Please see here: https://natashatracy.com/mental-illness-issues/addiction/psych-meds-addictive-antidepressants/
– Natasha Tracy
So sad, the whole “it’s not addiction if X” semantics game. Withdrawal means addiction, it means dependence. Labeling it as “discontinuation syndrome” etc, is just an attempt to obfuscate that point.
There is Akathisia. There is Tardive Dyskinesia and there is Serontonin Syndrome… all which has plagued me in the past.
Akathisia is akin to, if not the, Restless Legs Syndrome. Both my parents (passed) had really bad cases of it and though my Mom just lived through it, my Dad was prescribed Gabapentin and he had said that it was a life saver for him.
As a side note: While he (Dad) was in hospital this past Spring, the docs failed to order the Gabapentin time and again. My Dad would move his legs wildly in the hospital bed and the medical staff chalked it up to agitation and aggressiveness due to a dementiated elderly man (he wasn’t dementiated) and would give him benzodiazepines to “calm him and sedate him” only for him to still move his legs wildly.
He had to have a trach put in due to surgery and for a long while, was unable to clearly speak through the trach. So, he was unable to communicate what was actually happening and he’d get agitated, yes. Yet the medical staff continued to sedate him even with Seroquel at one point until I asked if he was getting his Gabapentin?
Uhm… no.
I explained that he had Restless Legs and they hurt and jerked and he had to move them to ease off the great discomfort. I explained that he had been prescribed the Gabapentin for years and it helped and why the hell did not they give it to him? (they had all his records in the “electronic chart”).
Well… they started giving it to him and wa la…. had one ICU doc actually thank me for making them aware of it but every time he got moved from floor to floor or unit to unit or rehab to rehab (in 3 months)… they always forgot the Gabapentin and he always displayed his wildly agitated kicking and moving. Medical staff chalked him up to a psychotic dementiated elderly man… which he wasn’t.
Back to the point at hand:
Tardive Dysinesia on the other hand is completely involuntary and is a adverse effect to many anti-psychotics/anti-epileptics. I had it with Compazine, Thorazine and Abilify and nearly had it with Seroquel (it started and I had the drug removed).
With the Compazine… I was a teenager receiving this old anti-psychotic and I had to actually receive Emergency medical treatment for which I received 2 shots because the 1st didn’t faze the involuntary neck and facial spasms that I was enduring (quite painful as well). My neck, involuntarily, kept pulling my head and right shoulder backwards and the longer it went, the worse it became.
Thorazine… prescribed during a 28 day inpatient stay due to psychosis (when in mid 20’s)… the doc gave me Cogentin along with due to the reaction I had with the Compazine. I had mild symptoms of but overall, it pretty much stunted that adverse effect.
Serontonin Syndrome is another thing entirely and is with anti-depressants. I had been on so many ADs for so many years (since childhood cause I was mis-diagnosed with Recurring Major Depressive with or without psychotic features depending on report) and was started on the brand new SSRIs.. (this was many years back) and BAM. Seriously, I thought surely I would die. Come to find out.. overload of Serontonin and it can actually kill.
Haven’t taken another AD since.
The SS, plus the suicidal impulse and the mania induced by…. nope, not another AD since and refuse when the pdocs insist on prescribing them to me… knowing the Bipolar and diagnosing me with Bipolar and still, many pdocs prescribing me the ADs along with benzodiazepines to offset the Serontonin, they say.
I do not necessarily trust pdocs especially when they refuse to hear me when I tell them of my adverse reactions to past trials and tribulations of medications… and smile and write me scripts for ADs and scripts for APs w/o the Cogentin… and then get upset when I pitch the prescriptions and tell them why….
I soon have a neuropsych test to determine (in my 30’s) if have ADHD or not. I was correctly diagnosed with bd in 2000, and live in recovery now, but through 2 antipsychotics, other meds, and therapy. Akathsia is what I’ve been going through, though!
Thank you for your timely post about this. I always tell my therapist I can’t stop moving and the thought of yoga or meditation seems impossible. And it wasn’t always this way.
I’m going to call my Dr to discuss this, so I won’t have to shell out hundreds for a test that may prove inconclusive.
Thank you, Natasha!
Staci
Re the Abilify it effected my heart!
At first they did electrocardiograpm it showed EXTREME ABMORMALITIES
I WAS FREAKING OUT DEMANDING TO BE TAKEN OFF THAT SHIT!
I DONT EVEN KNOW IF ITS AVAILABLE HERE ( IN ONTARIO, CDA)
SHEESH………
EVENTUALLY AFTER D/C THE DEVIL MED MY HEART IS HEALTHY AGAIN PLUS EXTRA HEALTHY FR NO ANIMAL PRODUCTS CONSUMED….
Another thing I think occurs,@ least has in the past before I’m FINALLY achieving a REAL
sense of CONTROL of this HELL OF A NIGHTMARE
Otherwise known in psychiatry as RAPID CYCLING BIPOLAR DISORDER……
Is I used to become SOOO frustrated HOW DAMN LONG the new med would be taking,& if the host of side effects were like a chemical waste problem…..
WELL?….COME ON….id get so pissed OFF actually realizing between side effects & my impatience…chances of a FAIL me secretly just STOPPING or making a DRS APPT ( generally this option,after all I’m 55!) & trying to hit the search button….
I honestly had it locked in my head THAT I WAS LITERALLY BEYOND HELP
After all,like so many I’d tried so many cocktails IM SENSITIVE TO MANY OF THESE DRUGS YET NEED THEM LIKE INSULIN TO LIVE.
However the one day your having one of the WORST MANIC …..SURPRISED?) YUP I WASNT HEADED FOR HOSPITAL WITH BELLS ON!
VERY HIGH, NO DRUGS yes still pres medications ( for my BP) HADNT SLEPT in few nites….long story capsulized
No pun intended!!!
This TYPE OF BP WHOEVER HAS IT PLEASE FOCUS ON MY COMMENT!!!
IT COULD SAVE YOU A HOSPITAL STAY OR MORE!!!
IM ASSUMING DRUG NAME SAME IF YOU ARE IN USA ITS A DRUG CALLED LATUDA
IT HAS LITERALLY SAVED MY LIFE!!!
Only side effect are occasional restlessness but it’s easing off the busier I am
Hence my saying we need to not dwell upon ourselves & GET BUSY!
Plus unfair to expect a CURE When LOGICALLY u know there is NONE
I figure if I can reduce the number of mood swings I get per DAY I AM ON THE RIGHT TRACK.
That’s exactly what this miracle pill has done…..
More exciting part?
Been on since June 29- My Psych says gradually my other psych meds can be lowered,but based symptomatically….we work as a TEAM…not oh here Sandra take this bye” well you get where I’m going.
For me as far as side effects the devil was HALDOL OMFG!!!!
SHOTS OR PILLS…..didn’t matter….I could hardly move yet I felt like a Mexican jumping bean!!!
Yes!
There’s a slew of others THORAZINE!!! 2- nd worst DEATH WARMED OVER UGGHHHHHH
Back on FLEEK
Just realize,my drug it’s tailored to us the peeps w RCBP mind you….if you don’t follow…the rules you must take it with @ least 350 cals worth of food to me ,ok though I’m vegan,I just eat @ dinner time.
Then,also as I still follow & intend staying vegan ex seafood so not complete) but all bad stuff out!
For 2 yrs still on psych drugs & back to my set point ( thin fast metabolism ) so yes some are genetically luckier.
Then,natch following normal everyday even weekend sleep routine to aid sleep,
No alcohol ( no prob hate it it makes me violent always) no illicit drugs ( jah 30 yrs ago,never touched since)
No caffeine ( also as high BP runs in fam.) plus after no coffee 3 yrs find crave desserts way less (???)
Take supplements ( Dr pres may missed by VEGANISM when fish prices very high here)
Plus MY RULE OF WHEN DEPRESSED DO 2 THINGS TO HELP MYSELF FEEL BETTER
When MANIC TRY & USE SOME ENERGY IF CAN IN A PRODUCTIVE MANNER INST DESTRUCTIVE …& HURTING OTHERS OR SPENDING ENORMUS $$$$ OR FLIRTING INAPPROPRIATELY.
IN CONDENDENSING SIMPLY REALLY TRY
When you find the med that balances you,yes you’ll still be triggered yes you’ll still have episodes.
BUT THE KEY TO THIS FOR ME MUCH MUCH FEWER ( the side effects from this vs other meds are like a walk in the park!! Plus I’ve more time before see my PSYCH AUG 30 so ABSOLUTE PEAK so IF IM THIS GOOD NOW?
Plus,EVERYONE WHO KNOWS ME HAS SAID SOMETHING! THEN YOU ARE REALLY SURE
Side effects too you can click the drug on Google ( don’t TELL YOUR DR) generally they don’t like patients doing this! But knowledge is EDUCATION,I’m a FIRM BELIEVER YOUR NEVER TOO OLD OR TOO YOUNG!
Oh I had this happen to me with one med. It is just AWFUL. I started getting the “twitchies” after a single dose and by the second I was unable to sleep, sit, rest, anything. Probably not surprisingly, I am not taking that drug any longer. I’ve never experienced anything so miserable – including the effects of the bipolar disorder itself! We determined that any benefits it might have had over the long run were not worth the inability to sleep, which is one of the primary triggers for my “normal” symptoms, if there is such a thing. For me, it was not even a question as to whether or not to keep taking it.
I had akathesia once and there was no out thinking or out maneuvering it. I was off the med after seven days. God what a wretched side effect.
There are some meds that are quite effective in combating this not uncommon side effect… Cogentin (benztropine) is the one most often used. As you say, sometimes it does diminish or disappear with time on its own. I heartily second your recommendation to tell your doctor about any side effects!
Obviously it depends upon the individual,as to how intense the side effects are…
Another option,while working together with your Dr is lessening the dose of the antagonist medication….gradually.
See if that helps….
I know for me my muscles get stiff hate that!!
Epsom salts warm baths where I force myself,bring in my iPad watch a lecture or concert….
Not only helps but freshens one & @ least in Ontario CDA we are in humidity hell!
I must due to lessen my side effects ( this is a winner) have had to listen to my 80 yr old neighbour across the hall
Do things GRADUALLY WE NEED OUR MEDS well,I’m speaking for MYSELF
I do understand with also every drug out there comes SOME SIDE EFFECTS
Just unfair we seem to get the shittiest….
But ending on a positive NOT NEGATIVE REMIND YOURSELF when the side effects bother you ( also try writing…
Even online not necessarily blogging but any frustrating things,GET OUT OF THAT MINDSET.
As that’s the mindset that may lead you to OH F IT IM GOING OFF THESE SHIT ASS DRUGS!!! TOO MUCH
OK The alternative?
Listen,I know there’s going to be mouths flapping I’m pushing pharmaceuticals.
I am,as it’s a genetic brain disorder…..you wouldn’t call a plumber to fix your digital TV & Internet????
I’ve tried vitamin therapies,only to become worse ECT my nuerologist thinks made my temporal lobe epilepsy
WORSE though just 8 ECTs) I’ve even religion…..FAIL FAIL
Like Natasha felt majority yrs like lab rat …..
In all,as in life,nothing is perfect…we should be fourtunate when we do hit the med jackpot,do out best & deal with it as best we know how……inc Dr may pres something for a patient whose daily LIFE was effected THEN ID SEEK
med attention STRAIGHT AWAY
Stay well,now back to the laundry ugh :( but living!!!!!
This happened to me on Abilify (aripiprazole) when I was in high school. Luckily for me, I had amazing teachers who understood and would let me take a break during class to walk around the halls if I needed to. I know it’s different for everyone but to me Abilify is the devil drug. It caused me nothing but problems.
Oh my goodness. This is all new to me. Of all the side effects I have experienced, I have not had this one and it sounds as though that is something to be thankful for.
Many times I have struggled with side effects and whether or not they are bad enough for me to quit a medication. Usually they are.
And so when I try a new med and it doesn’t even work but there are no side effects I am tempted to stay on it which is just silly I know. I stop taking it.
Now I am on a medication that helps just a wee bit and has no side effects. I am hanging onto that and using my strategies for the rest.
Thanks for the helpful information.