Akathisia: Causes, Symptoms and How to Treat

Written by Medicover Team and Medically Reviewed by Dr Prachi Rahul Pawar , Neurologists

Akathisia is a complex and often debilitating condition characterised by an overwhelming sense of inner restlessness and an uncontrollable need to move. It can significantly impact daily life, making routine activities difficult.

Understanding its symptoms, causes, and treatment options helps in early recognition and effective management.

What Are the Types of Akathisia?

Akathisia is classified based on how quickly symptoms appear and how long they last. The common types include:

Acute Akathisia

Acute akathisia typically develops within hours to days of starting or increasing medication dosage. It is the most common type and often improves once the medication is adjusted.

Chronic Akathisia

Chronic akathisia lasts for more than three months and may continue even after stopping the causative drug, requiring long-term management.

Tardive Akathisia

Tardive akathisia develops after prolonged use of antipsychotic medications and may appear even after discontinuation. It can be difficult to reverse and needs specialised care.

Withdrawal Akathisia

This type occurs when medications are suddenly stopped or rapidly reduced. Although usually temporary, symptoms can be intense during withdrawal.

What Are the Symptoms or Warning Signs of Akathisia?

Physical Symptoms

The hallmark of akathisia is a compelling need to move, often manifesting through noticeable physical behaviours such as:

These movements are generally involuntary and often act as a way to temporarily relieve the intense inner restlessness.

Psychological Symptoms

Along with physical signs, individuals may also experience emotional and mental discomfort, including:

These symptoms can intensify physical restlessness, making the condition more challenging to manage.

What Causes Akathisia?

Akathisia can develop due to medication-related and non-medication-related factors that affect brain chemistry and movement control.

Pharmacological Causes

The most common cause is the use of antipsychotic medications, especially first-generation types. These drugs interfere with dopamine pathways in the brain, contributing to the development of symptoms.

Non-Pharmacological Causes

In some cases, akathisia may arise from other medical or neurological conditions such as:

When Should You See a Doctor for Akathisia?

Medical attention is necessary if symptoms of restlessness or unusual movements appear, especially after starting or changing medications.

A neurologist or psychiatrist is typically involved in diagnosing and managing akathisia, depending on the underlying cause.

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How is Akathisia Diagnosed?

Diagnosis of akathisia is primarily clinical and focuses on identifying symptoms and their link to medication use.

Clinical Evaluation

A detailed medical history and physical examination help identify characteristic signs and their timing in relation to medications.

Rating Scales

Tools like the Barnes Akathisia Rating Scale (BARS) are used to measure symptom severity and monitor treatment response.

Differential Diagnosis

It is important to distinguish akathisia from other conditions such as restless legs syndrome, tardive dyskinesia, and anxiety disorders to ensure correct treatment.

What Are the Treatment Options for Akathisia?

Treatment focuses on addressing the underlying cause, relieving symptoms, and improving overall comfort.

Pharmacological Treatments

Medication Adjustments

Reducing the dose or discontinuing the causative medication is often the first step. Switching to alternatives with lower risk may also help.

Adjunctive Medications

Additional medications can help manage symptoms effectively, such as:

Non-Pharmacological Treatments

Behavioral Therapies

Therapies such as cognitive-behavioral therapy (CBT) can help individuals cope with emotional distress.

Lifestyle Modifications

Regular exercise, relaxation techniques, and maintaining a routine can support symptom management and overall well-being.

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What is the Recovery Process for Akathisia?

Recovery varies depending on the type and cause of akathisia. Early identification and proper treatment can significantly improve outcomes.

Prevention of Akathisia

Risk Assessment

Before initiating medications known to cause akathisia, a careful evaluation of the patient's medical history and risk factors is essential.

Slow Titration

Gradually increasing medication dosage instead of sudden changes can reduce the likelihood of developing symptoms.

Patient Education

Educating patients about potential side effects and encouraging early reporting of symptoms supports timely intervention.