(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.
Next, please see the various articles on this website about medication-induced akathisia. They are listed below under Related Pages.
Related Pages
Akathisia: Introduction
Akathisia: Clinical features
Which second-generation antipsychotics have a lower or higher risk of causing akathisia?
Is lumateperone less likely to cause extrapyramidal symptoms (including parkinsonism or akathisia)?
Akathisia: Identification and evaluation
Barnes Akathisia Rating Scale
Akathisia: Treatment
Akathisia: Treatment
Mirtazapine may cause akathisia at higher doses
Gabapentin for the treatment of akathisia?
Anticholinergics for the treatment of akathisia?
Amantadine for the treatment of akathisia?
Vitamin B6 for the treatment of akathisia?
Main menu: Side-effects
References
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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Dear Dr. Mago, in referrance to any the typical rating scales used in practice (PHQ 9, GAD 7, MDQ, etc.), patients sometimes ask how long a part of the day they must be feeling symptomatic for it to “count”, ex. how an hour ever few days or so, or say one whole day (would that count as “several days, scored as 1 on the PHQ and GAD)?
Any clarification of the nuances involved be greatly appreciated.
Dr. Dattu