What Is Akathisia?

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Table of Contents

Types

Symptoms

Diagnosis

Causes

Treatment

Coping

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This article discusses the symptoms and different types of akathisia. It also explores why it happens, how it is diagnosed, and treatments that can help people cope.

Types of Akathisia

There are several types of akathisia, depending on the onset and longevity of symptoms:

Symptoms of Akathisia

If you have akathisia, you may have restless movements of the arms and legs. This is sometimes referred to aspsychomotor 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.

Common signs of akathisia include:

Other symptoms include:

Diagnosis of Akathisia

Akathisia is generally underdiagnosed or misdiagnosed. The prevalence of missed diagnosis is a dangerous problem as it can lead to negative outcomes such as missed medication dosages, which may exacerbate the psychiatric symptoms the drugs are meant to help manage.

If you suspect akathisia, it’s important to see your doctor to get an official diagnosis. Do not stop taking medication on your own.

To diagnose akathisia, your doctor will likely perform a physical exam, which includes observing you sitting and standing for several minutes to watch for psychomotor agitation. Your doctor may also fill out the Barnes Akathisia-Rating Scale to assess the severity of your symptoms. This tool can also be used to track your progress during treatment.

Conditions With Similar Symptoms

Akathisia has some similarities to other conditions, including anxiety and tardive dyskinesia. While these conditions may have overlapping symptoms, they are not the same.

Your doctor will ask about your current medications and rule out any other health conditions that can cause similar symptoms, including:

For example, anxiety is a mental health condition that may cause some restlessness, but it does not create an uncontrollable compulsion to constantly move. While worry and fear that are characteristics of anxiety are not symptoms of akathisia, the condition can be anxiety-provoking for many people.

Tardive dyskinesia involves involuntary movements of the face, fingers, or extremities. Like akathisia, it is a side effect of antipsychotic medications. These movements are involuntary, whereas akathisia involves an internal feeling of restlessness. The two conditions can also occur together.

RecapA doctor will observe symptoms to make a diagnosis. Because akathisia can resemble other conditions, it is sometimes misdiagnosed as anxiety or agitation.

Recap

A doctor will observe symptoms to make a diagnosis. Because akathisia can resemble other conditions, it is sometimes misdiagnosed as anxiety or agitation.

Causes of Akathisia

Not everyone who takes antipsychotic drugs will experience akathisia, however, it is often a side effect of older, first-generation antipsychotics used to treat bipolar disorder and schizophrenia, including:

Akathisia is also common with haloperidol and the newer, second-generation agentsAbilify (aripiprazole)and Latuda (lurasidone). Invega (paliperidone) andGeodon (ziprasidone)are on the very low end of medications thought to cause akathisia.

It’s important to note that all antipsychotic drugs carry with them the risk of causing akathisia.

Other medications known to cause akathisia include:

Unfortunately, just as starting antipsychotic medication may cause akathisia, it is also observed in people who are being gradually taken off their antipsychotic medication or may be advised to gradually decrease their dosages. In these instances, intensedysphoriais often observed as well.

Treatment for Akathisia

If you’ve been diagnosed with akathisia, your doctor may decrease your dosage or discontinue the medication causing your symptoms. However, modifying your mediation may also cause symptoms to worsen, or cause withdrawal akathisia.

A number of medications have been used to treat the symptoms of akathisia, including:

Akathisia is generally treatable if it is diagnosed and treated early and the individual is able to stop taking the drug that is causing the problem. Akathisia often goes away after lowering the dosage of the medication. It may take several weeks or months for symptoms to resolve.

When left untreated, the prognosis is poorer, and symptoms may have a serious effect on a person’s quality of life. The condition is also linked to an increased risk of anxiety, depression, and thoughts of suicide.

If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

Coping With Akathisia

An important part of coping with akathisia is managing your medication. Do your best to keep a detailed record of the medications you are taking, including the dosage and when you started taking them. If you experience any symptoms of akathisia, share the record with your healthcare provider.

While your prescribing doctor should have your medication history, they may not have it in a compact form.

If you’re feeling alone or frustrated about your symptoms, it can also help to confide in a trusted friend or family member. Consider joining an online support group of others who understand what you’re going through.

Prevention

Doctors and researchers do not yet fully understand the exact reasons why certain medications cause akathisia. However, certain factors that can increase your risk and trigger akathisia include:

While akathisia cannot always be prevented, your risk is lower if you start on the lowest dose. Your doctor may then increase your dose gradually.

If you or a loved one are struggling with a mental health issue, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat1-800-662-4357for information on support and treatment facilities in your area.For more mental health resources, see ourNational Helpline Database.

If you or a loved one are struggling with a mental health issue, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat1-800-662-4357for information on support and treatment facilities in your area.

For more mental health resources, see ourNational Helpline Database.

9 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders.5th ed. Washington D.C.: 2013. doi:10.1176/appi.books.9780890425596Salem H, Nagpal C, Pigott T, Teixeira AL.Revisiting antipsychotic-induced akathisia: Current issues and prospective challenges.Curr Neuropharmacol. 2017;15(5):789–798. doi:10.2174/1570159X14666161208153644Salem H, Nagpal C, Pigott T, Teixeira AL.Revisiting antipsychotic-induced akathisia: Current issues and prospective challenges.Curr Neuropharmacol. 2017;15(5):789-798. doi:10.2174/1570159X14666161208153644Forcen F.Akathisia: Is restlessness a primary condition or an adverse drug effect?Current Psychiatry. 2015;14(1):14-18.Barnes TR.The Barnes Akathisia Rating Scale–revisited.J Psychopharmacol(Oxford). 2003;17(4):365-70. doi:10.1177/0269881103174013Musco S, Ruekert L, Myers J, Anderson D, Welling M, Cunningham EA.Characteristics of patients experiencing extrapyramidal symptoms or other movement disorders related to dopamine receptor blocking agent therapy.J Clin Psychopharmacol.2019;39(4):336-343. doi:10.1097/JCP.0000000000001061Thomas JE, Caballero J, Harrington CA.The incidence of akathisia in the treatment of schizophrenia with aripiprazole, asenapine and lurasidone: A meta-analysis.Curr Neuropharmacol. 2015;13(5):681-91. doi:10.2174/1570159X13666150115220221Pringsheim T, Gardner D, Addington D, et al.The assessment and treatment of antipsychotic-induced akathisia.Can J Psychiatry. 2018;63(11):719-729. doi:10.1177/0706743718760288Kalniunas A, Chakrabarti I, Mandalia R, Munjiza J, Pappa S.The relationship between antipsychotic-induced akathisia and suicidal behaviour: A systematic review.Neuropsychiatr Dis Treat. 2021;17:3489-3497. doi:10.2147/NDT.S337785

9 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders.5th ed. Washington D.C.: 2013. doi:10.1176/appi.books.9780890425596Salem H, Nagpal C, Pigott T, Teixeira AL.Revisiting antipsychotic-induced akathisia: Current issues and prospective challenges.Curr Neuropharmacol. 2017;15(5):789–798. doi:10.2174/1570159X14666161208153644Salem H, Nagpal C, Pigott T, Teixeira AL.Revisiting antipsychotic-induced akathisia: Current issues and prospective challenges.Curr Neuropharmacol. 2017;15(5):789-798. doi:10.2174/1570159X14666161208153644Forcen F.Akathisia: Is restlessness a primary condition or an adverse drug effect?Current Psychiatry. 2015;14(1):14-18.Barnes TR.The Barnes Akathisia Rating Scale–revisited.J Psychopharmacol(Oxford). 2003;17(4):365-70. doi:10.1177/0269881103174013Musco S, Ruekert L, Myers J, Anderson D, Welling M, Cunningham EA.Characteristics of patients experiencing extrapyramidal symptoms or other movement disorders related to dopamine receptor blocking agent therapy.J Clin Psychopharmacol.2019;39(4):336-343. doi:10.1097/JCP.0000000000001061Thomas JE, Caballero J, Harrington CA.The incidence of akathisia in the treatment of schizophrenia with aripiprazole, asenapine and lurasidone: A meta-analysis.Curr Neuropharmacol. 2015;13(5):681-91. doi:10.2174/1570159X13666150115220221Pringsheim T, Gardner D, Addington D, et al.The assessment and treatment of antipsychotic-induced akathisia.Can J Psychiatry. 2018;63(11):719-729. doi:10.1177/0706743718760288Kalniunas A, Chakrabarti I, Mandalia R, Munjiza J, Pappa S.The relationship between antipsychotic-induced akathisia and suicidal behaviour: A systematic review.Neuropsychiatr Dis Treat. 2021;17:3489-3497. doi:10.2147/NDT.S337785

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders.5th ed. Washington D.C.: 2013. doi:10.1176/appi.books.9780890425596Salem H, Nagpal C, Pigott T, Teixeira AL.Revisiting antipsychotic-induced akathisia: Current issues and prospective challenges.Curr Neuropharmacol. 2017;15(5):789–798. doi:10.2174/1570159X14666161208153644Salem H, Nagpal C, Pigott T, Teixeira AL.Revisiting antipsychotic-induced akathisia: Current issues and prospective challenges.Curr Neuropharmacol. 2017;15(5):789-798. doi:10.2174/1570159X14666161208153644Forcen F.Akathisia: Is restlessness a primary condition or an adverse drug effect?Current Psychiatry. 2015;14(1):14-18.Barnes TR.The Barnes Akathisia Rating Scale–revisited.J Psychopharmacol(Oxford). 2003;17(4):365-70. doi:10.1177/0269881103174013Musco S, Ruekert L, Myers J, Anderson D, Welling M, Cunningham EA.Characteristics of patients experiencing extrapyramidal symptoms or other movement disorders related to dopamine receptor blocking agent therapy.J Clin Psychopharmacol.2019;39(4):336-343. doi:10.1097/JCP.0000000000001061Thomas JE, Caballero J, Harrington CA.The incidence of akathisia in the treatment of schizophrenia with aripiprazole, asenapine and lurasidone: A meta-analysis.Curr Neuropharmacol. 2015;13(5):681-91. doi:10.2174/1570159X13666150115220221Pringsheim T, Gardner D, Addington D, et al.The assessment and treatment of antipsychotic-induced akathisia.Can J Psychiatry. 2018;63(11):719-729. doi:10.1177/0706743718760288Kalniunas A, Chakrabarti I, Mandalia R, Munjiza J, Pappa S.The relationship between antipsychotic-induced akathisia and suicidal behaviour: A systematic review.Neuropsychiatr Dis Treat. 2021;17:3489-3497. doi:10.2147/NDT.S337785

American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders.5th ed. Washington D.C.: 2013. doi:10.1176/appi.books.9780890425596

Salem H, Nagpal C, Pigott T, Teixeira AL.Revisiting antipsychotic-induced akathisia: Current issues and prospective challenges.Curr Neuropharmacol. 2017;15(5):789–798. doi:10.2174/1570159X14666161208153644

Salem H, Nagpal C, Pigott T, Teixeira AL.Revisiting antipsychotic-induced akathisia: Current issues and prospective challenges.Curr Neuropharmacol. 2017;15(5):789-798. doi:10.2174/1570159X14666161208153644

Forcen F.Akathisia: Is restlessness a primary condition or an adverse drug effect?Current Psychiatry. 2015;14(1):14-18.

Barnes TR.The Barnes Akathisia Rating Scale–revisited.J Psychopharmacol(Oxford). 2003;17(4):365-70. doi:10.1177/0269881103174013

Musco S, Ruekert L, Myers J, Anderson D, Welling M, Cunningham EA.Characteristics of patients experiencing extrapyramidal symptoms or other movement disorders related to dopamine receptor blocking agent therapy.J Clin Psychopharmacol.2019;39(4):336-343. doi:10.1097/JCP.0000000000001061

Thomas JE, Caballero J, Harrington CA.The incidence of akathisia in the treatment of schizophrenia with aripiprazole, asenapine and lurasidone: A meta-analysis.Curr Neuropharmacol. 2015;13(5):681-91. doi:10.2174/1570159X13666150115220221

Pringsheim T, Gardner D, Addington D, et al.The assessment and treatment of antipsychotic-induced akathisia.Can J Psychiatry. 2018;63(11):719-729. doi:10.1177/0706743718760288

Kalniunas A, Chakrabarti I, Mandalia R, Munjiza J, Pappa S.The relationship between antipsychotic-induced akathisia and suicidal behaviour: A systematic review.Neuropsychiatr Dis Treat. 2021;17:3489-3497. doi:10.2147/NDT.S337785

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