Psychiatrist Questions

suffering from akathisia

I am 39 years old and I took soltus 400 and risodone for nearly a year Now I have severe akathisia and restlessness and unable to sleep I took propanolol 20mg and clonazepam 0.5 mg but not help. please advise.

Male | 39 years old
Complaint duration: 1 year
Conditions: akathisia

4 Answers

You should speak to your psychiatric provider about possible medication
adjustments. You might be exposed to an increased risk of these side
effects since you are on two antipsychotics.
I am so sorry to hear you’re having akathisia. It can truly be so very very bothersome. Let me preface the following ideas by stating that the medicine Soltus is not used in the United States for various reasons. However, akathisia issues are worldwide. The first thing many of us do is try beta blockers like propranolol. Depending on your cardiac status, and physiology, and sensitivity to this medication. The several sources that I have consulted use from 30 mg to 80 mg per day, and one source was 60 mg to 120 mg per day. Obviously consult with your physician. The use of a benzodiazepine is very common. It’s one of the first augmentation strategies given in conjunction with a beta blocker. One of the more common benzodiazepines used here in the United States is diazepam. Various doses have been used. Once one goes beyond beta blockers with benzodiazepine augmentation, the scientific evidence for alternative interventions is not as solid. Some of the medication‘s that are used include the medicine clonidine instead of a beta blocker. Other alternatives include Cyproheptadine,mianserin, Mirtazapine, and medicines in the class of anti-muscarinic‘s like benztropine. Always follow your doctor‘s advice. Wishing you only the best.

Lance Steinberg MD, Inc.
Assistant Clinical Professor
UCLA (Geffen) NPI
Propranolol is the medication typically used for akathisia. If this did not help I would consider trying medications targeted at treating extrapyramidal symptoms such as cogentin. Of course, making sure you are off any medications that could be contributing to the side effects or at least minimizing them would be needed.
Thanks for reaching out. Akathisia is a truly bothersome problem. Your provider should be able to discuss options with you to help. Beta blockers and benzodiazepines are usually starting points for treatment. If you haven't seen a neurologist or a movement disorders specialist, especially if these two options have been helpful, that would be my next suggestion. They could have additional recommendations to help you. You should talk to your provider about your ongoing struggles and see if they think a referral is appropriate. Good luck!