What is akathisia?

Akathisia is a relatively common medication side effect. Akathisia is a feeling of restlessness that many people find difficult to describe. Many people with akathisia say that it makes them feel like they would like to crawl out of their skin.

What does akathisia feel like?

Akathisia can be just an uncomfortable feeling. But for many people that feeling of restlessness translates into not being able to sit still. (Akathisia comes from Greek words that mean “not able to sit down”). It can involve fidgeting, or not being able to sit down or lie down for very long without having to move. Akathisia can manifest as walking or pacing as well.

What causes akathisia?

Akathisia is sometimes a symptom of neurological illnesses (like Parkinson’s disease), but most of the time akathisia is a medication side effect.

Medications used to treat psychosis or schizophrenia are the most common cause of akathisia. But antidepressants can cause akathisia. So can some treatments for nausea or vomiting.

Akathisia treatment

Akathisia is relatively easy to treat. The most common treatments for akathisia are: reducing the dose of the medication that’s causing it, or getting rid of the medication and switching to a different one. The most common medication treatments for akathisia are propranolol or lorazepam. Other treatment options that have been studied include: cyproheptadine, vitamin B6, benztropine (Cogentin), or diphenhydramine (Benadryl).

In this week's episode, Melissa and Dr. Erik answer questions like:

• What is akathisia?
• What causes akathisia?
• What are the best treatments for akathisia?

Topics covered:

0:44

What is Akathisia?

02:11

Akathisia can consist of feelings or of movements.

3:32

What causes Akathisia?

6:36

Akathisia is a frequently missed or unrecognized side effect.

7:59

Why is Akathisia an often-unrecognized side effect?

10:40

The feeling of Akathisia is hard to express

14:25

A description of what Akathisia looks like

20:20

What to do when a medical problem does not respond to textbook solutions?

23:59

Antidepressant medications can cause Akathisia

26:17

Some medications for nausea or vomiting can cause Akathisia.

28:25

A tragic story of missed Akathisia in the emergency department

30:18

Advice and possible solutions for someone who might be experiencing restlessness

33:07

Weighing your options and choosing the right medications

About the Podcast:

Dr. Erik Messamore is a board-certified psychiatric physician and PhD-level pharmacologist. He’s a consultant psychiatrist, researcher, lecturer, teacher, and solution-focused scholar currently affiliated with the Northeast Ohio Medical University in Rootstown, Ohio. He is joined on this podcast by Melissa Xenophontos, a journalist, radio producer and longtime mental health advocate.

Send us a question

Useful Links

Dr. Erik’s website and blog

Podcast website

Ask A Psychiatrist YouTube Channel