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What is Akathisia?

What is Akathisia?

Akathisia is a condition that causes a feeling of restlessness and a big need to move. Akathisia is a side effect of older, first-generation antipsychotic drugs used to treat mental health conditions like bipolar disorder and schizophrenia, but it can also occur with newer antipsychotics as well. Between 20 and 75 percent of people who take these medicines have this side effect, especially in the first few weeks after they start the treatment.

What Causes Akathisia?

Not everyone taking an antipsychotic drug gets the disorder. Symptoms usually appear within a few days. Older, first-generation versions of these drugs are more likely to cause akathisia than newer ones. You’re also more likely to get it if you start with a high dose, suddenly increase the dose, or stop a medicine suddenly.

Older antipsychotic drugs that may cause akathisia include:

  • Chlorpromazine
  • Droperidol
  • Fluphenazine
  • Loxapine
  • Pimozide
  • Prochlorperazine
  • Thiothixene

Signs and symptoms

The main aspect of akathisia that people experience is the sense of restlessness and a deep urge to move. Many people with akathisia may also experience any or all of the following symptoms:

  • anxiety
  • a sense of impatience
  • panic
  • increased irritability

People with akathisia can try to relieve their sense of restlessness and urge to move by doing any of the following:

  • pacing
  • shuffling or dragging the feet while walking
  • tapping feet or crossing and uncrossing legs while seated
  • lifting knees high while walking as if marching
  • shifting weight from one foot to the other or rocking back and forth while standing

The Prevalence of Akathisia

Between 20% and 45% of people who take antipsychotic medications experience akathisia. The Barnes Akathisia-Rating Scale is used to diagnose the condition. If you happen to suffer from akathisia, you may have restless movements of the arms and legs such as tapping, marching in place, rocking, crossing and uncrossing the legs. This is sometimes referred to as psychomotor agitation. Your body may feel anxious at the thought of sitting down. Your body will always want to be on the move, almost to the point of fidgeting whenever stillness sets in.

How Is It Diagnosed?

It’s important to see your doctor if you have symptoms of akathisia. If left untreated, it can lead to distress, disruptive behaviors, or worsened psychosis. Don’t stop taking medications unless your doctor says it’s OK. To diagnose akathisia, your doctor will do a physical exam. They’ll ask you everything about your medical history and what medications you’re taking. You’ll also sit and stand for a few minutes. They’ll watch for symptoms like rocking or shuffling. They may fill out a rating scale like the Barnes Akathisia Rating Scale to judge how severe your symptoms are and track your progress as you’re treated.


The first step in treatment is to reevaluate the medication that caused akathisia. Also, a doctor may prescribe additional medications such as:

  • antiviral drugs
  • benzodiazepines
  • blood pressure medicines

Some studies indicate that vitamin B-6 may help with cases of akathisia. High doses of vitamin B-6 were tested alongside an antidepressant and a placebo. The results indicated that vitamin B-6 improved symptoms better than a placebo did. The antidepressant, mianserin, also improved symptoms. People who need antipsychotic medication usually receive a low dose at first and build up slowly.

Once you stop taking the medicine that caused akathisia, the symptom should go away. However, there are some people who may continue with a mild case, despite stopping the medication. It’s very important to get akathisia treated as quickly as possible. When left untreated it can make psychotic behavior worse. This condition may also prevent you from taking medicine you need to treat a mental illness. Some people with akathisia have had suicidal thoughts or violent behavior. Akathisia can also increase your risk for tardive dyskinesia.