(Updated January 2019)
What is akathisia?
Akathisia is a very common, very bothersome, and potentially serious adverse effect of medications including antipsychotics, antidepressants, antiemetics, etc. It consists of a feeling of inner restlessness that is often but not necessarily accompanied by observable physical restlessness.
Why is akathisia so important?
1. It is common. Akathisia is not rare. With some medications, it is quite common. For example, in clinical trials of aripiprazole as an adjunctive treatment in patients with major depressive disorder, the drug-placebo difference for the incidence of akathisia was 21% (Abilify Prescribing Information). For brexpiprazole as an adjunctive treatment for MDD, the drug-placebo difference was 7% (Rexulti Prescribing Information). Note: the studies for aripiprazole and brexpiprazole were conducted differently, so these percentages should not be compared against each other.
2. Akathisia causes significant distress to the patient and so it can lead to non-adherence to the medication.
3. It can also lead to secondary effects like insomnia, aggressive behavior, and suicidality (Drake and Ehrlich, 1985).
4. It is believed that patients who have akathisia may be more likely to subsequently develop tardive dyskinesia.
Drake RE, Ehrlich J. Suicide attempts associated with akathisia. Am J Psychiatry. 1985 Apr;142(4):499-501. PubMed PMID: 3976927.
Miller CH, Fleischhacker WW. Managing Antipsychotic-induced acute and chronic akathisia. Drug Safety 2000; 22 (1): 73-81. PubMed PMID: 10647977.
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