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Akathisia vs restlessness, anxiety, agitation

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There's an interesting discussion of akathisia buried in this May 25, 2011 post by psychiatrist Steve Balt http://carlatpsychiatry.blogspot.com/2011/05/horizant-second-coming-of-gabapentin.html

 

".... However, the symptoms of RLS (restless leg syndrome) are rather nonspecific: "an urge to move the limbs, which improves with activity and worsens with rest." That's about it. Which leads to yet another problem (a problem that GSK and Xenoport don't see as a problem, that's for sure): with such vague and common symptoms (who among us hasn't felt somewhat restless at times, with interrupted sleep?), a lot of people might get diagnosed with RLS when their symptoms are actually due to something else.

 

A while back, a fellow blogger directed me to the RLS "patient page" on the National Institutes of Health (NIH) web site, where RLS was—and still is—referred to as "akathisia." However, these may be two entirely different things. Akathisia (from the Greek for "not sitting still") has long been recognized as a side effect of some—perhaps most—psychiatric medications, from antipsychotics to antidepressants. It is often described as an "inner restlessness," a "need to keep moving." Sometimes it's associated with extreme emotional distress. In terms of severity, it can range from a mild nuisance to—in some cases—aggressive tendencies. (Indeed, the psychiatrist David Healy has even linked psychotropic-induced akathisia to suicide attempts and violent behavior.)

 

Psychiatrists really don't know exactly what causes akathisia, and disagree on how to treat it. It may have something to do with dopamine blockade, or something completely independent. Treatment might consist of benzodiazepines (like Ativan or Valium), beta blockers (like propranolol), or discontinuing the drug that caused it in the first place.

 

Unlike RLS, which seems to bother people most when they are lying down (hence its tendency to disrupt sleep), drug-induced akathisia is worse when people are awake and moving around. Sounds like a simple distinction. But nothing is quite this simple, particularly when psychiatric drugs—and real people—are involved. In fact, many psychiatric meds can cause other motor side effects, too, involving (theoretically) yet other neural pathways, such as "parkinsonian" side effects like rigidity and tremor. In fact, some antipsychotic drug trials show "restlessness" and "akathisia" as entirely separate side effects (and when I've tried to ask experts to explain the difference, I have never received a straightforward answer.) ...."

Edited by Altostrata
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This is what a knowledgeable doctor told me:

 

Agitation is relieved by moving around, but akathisia and restless leg syndrome (RLS) are not. All of them are related to dopaminergic dysregulation; it is unclear whether it's too much dopamine or too little dopamine, this could vary from person to person, or even in the same person, producing the same symptoms. Dopaminergic dysregulation is the key.

 

The doctor said he wouldn't try to treat dopaminergic dysregulation with drugs. From what he's seen, it resolves in time.

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i've had akathesia 24/7/365 for teh past 3 years. didnt know it had to do with dopamine. are there any suppliments that can help the dopamine and help the akathesia?

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Hi Earthworm...welcome to the board!

 

Notice the post above yours...Surviving's doctor says the agitation/akathisia resolves evenually once you are drug free, and that he does not prescribe for it. I had it very bad for a long time during my protracted w/d, but it has resolved. I do think that walking can help.

 

I don't really think that there are any supplements that really help this problem. I had to be very careful when taking supplements because sometimes they made my symptoms worse...Omega 3 for example helps many, but made me feel like bouncing off the walls.

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i've had akathesia 24/7/365 for teh past 3 years. didnt know it had to do with dopamine. are there any suppliments that can help the dopamine and help the akathesia?

 

hi earth,

 

as said above, you have to wean totally to have a chance akathisia go away

akathisia do not exist in life, it is only drug induce

if you are taking drugs, you can have 10 years akathisia

i catch severe akathisia from month 9 off to maybe 15 months off, i all read about this hell, and do what i found : waiting time pass without any nerve med,i was despair and one day i discover it was less intense and gone away(i have maybe mild mild residual akathisia, but i am not sure)

i found only two peoples on sri who had akathisia after 2/3 years, i analysed their history and the two were taking nerve meds to help their akathisia

nerves med = sri or beta blocker or xanax or neuroleptic(France) which work on dopamine(antipsychotic in america i think)

more years you are on , more it will be difficult to wean

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Hey, Earthworm! Welcome to SA.

 

Trying supplements may be a tricky thing. In WD we are super-sensitive to more than we're not. Your best bet would be to let the body heal on its own, and at its own pace. Our system is able to find the shortest way to healing (though still much too long for most of us), and too much stimulation may keep throwing it off balance.

 

You will be continually improving. Just a few more steps. Take care!

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im granturissimus from PP by the way.

 

getting off the pills is not an option for me. i've tried tapering really slow (0.1mg every 2 weeks) and all that happened was that i crashed severely. that was a year ago, and i still have not got to my pre crash condition. i'd sure like to be off these pills, and i might start a taper again eventually, but i know its impossible for me to get off this stuff. the crashes are too horrific and unbearable.

 

thats why i need advice about what to do about my simptoms while im still on drugs. no one on earth would be able to survive the crashes i've been in. one would last maybe 2 weeks and then kill themselves. it is impossible to get through them.

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im granturissimus from PP by the way.

 

getting off the pills is not an option for me. i've tried tapering really slow (0.1mg every 2 weeks) and all that happened was that i crashed severely. that was a year ago, and i still have not got to my pre crash condition. i'd sure like to be off these pills, and i might start a taper again eventually, but i know its impossible for me to get off this stuff. the crashes are too horrific and unbearable.

 

thats why i need advice about what to do about my simptoms while im still on drugs. no one on earth would be able to survive the crashes i've been in. one would last maybe 2 weeks and then kill themselves. it is impossible to get through them.

 

hi, i guess you,

 

it is a deadlock

as to throw akathisia you have to be meds free , and actually you cannot

when you will be in a better situation ,wean slowly and try betablocker propanolol to feel relief but it has many side effects and the risks are you may have blood problems...

 

what i would try in your case :

from my memory you are on 30 mg

i would wean very slowly to 20 mg, wait a while and then wean to 15 mg and wait more more time

the goal would be to not be on a high dose, 15 mg is better than 30 mg, and after time to continue

paxil cures nothing and gives you akathisia

 

cheer up !

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Earthworm,

 

Don’t feel like you will never get off of these drugs…I did it and I am much older than you. It is horrific for some of us, but it can be done. It takes time and patience, but it is worth it in the end…you are very young and will eventually have a great life drug free!

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tehre are many people on PP that cant taper off just like me. songbird is one of them, and i think rachelina and aussigirl (not sure its them, i forgot who it was). when they taper down to a certain dose below 5mg or so, they just crash. and im exactly like them. i got to 3.6 mg and i crashed one morning out of nowhere... all hell just hit me at once... akathesia got way worse, ocd went off the scale to suicide level, physical terror (not mental terror) overwhelmed my body, and i was not able to sleep at all, or eat. all those at the same time are unsurvivable.

 

i cant cheer up stan. im still on pills and i have 24/7/365 akathesia, cant sleep for s*** and require risperdal to get me some cheap sleep, and i have terrible chemical OCD that torments me like a mother f-er for the past 3 years. and i have a lot more symptoms as well, but those are my big 3. and when i try to taper all these symptosm get waaaaaaaaaaaaay worse to suicide level. im stuck. if i feel like s*** 24/7 on pills, what is it going to be when im off pills? my experience says that i will be a million times worse off pills. i've been on pills for 3 years so far after my reinstatement, and nothing changed, i never stabalized. all that happened was that my akathesia got lower as the years on the dose went on.

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I'm so sorry you're going through such a terrible experience!

 

I don't know this for sure, but it seems to me that, *generally speaking*, young men are most likely to have the worst akathisia. (There are always exceptions, of course.) Maybe it has to do with testosterone. Have you looked into this angle at all?

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i didnt do much research on akathisia so i dont know much.

 

i found this article just now though: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1192441/

 

talks about propranolol for treatment of drug induced akathisia. im despirate for any help i can get. anyone know of propranolol for akathisia?

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i didnt do much research on akathisia so i dont know much.

 

i found this article just now though: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1192441/

 

talks about propranolol for treatment of drug induced akathisia. im despirate for any help i can get. anyone know of propranolol for akathisia?

 

the problem is that it is the celexa and risperdal(and before meds) who gave akathisia and maintain it today as long as they are taken

it is a cycle without end

to broke the cycle : taper

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akathisia is a result of amount receptors fired by celexa, risperdal, lamictal and ...

as long as you are taken these psy meds you are continuing to firering more receptors (myself am a victim of time taken 13 years)

there is no miracle, the damaged receptors will need more time to recover as you have taken high doses and longer time

it exist any meds to heal this

what do people in your case to have success : taper and then wait nerves healing

 

cheer up !

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Actually the opposite it true. With Akathesia you get relief when you move and with agitation it is only a minor distraction. I have severe agitation and no amount of movement helps.

 

I have a good friend in Canada that has been to a specialized Akathesia clinic in Vancouver. If he even gets off the couch to go to the kitchen he can sense some relief. The differential diagnosis for akathesia is body anxiety/tension relieved by movement

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From Current Psychiatry Online http://www.currentpsychiatry.com/article_pages.asp?aid=9691#4 :

 

Akathisia and suicide. Unrecognized or undertreated akathisia is most commonly associated with antipsychotics, but also can occur with SSRIs. Although akathisia is commonly thought of as a motor syndrome of restlessness, patients may find the less-recognized psychic symptoms of increased inner turmoil and hallucinations just as distressing. This complex of symptoms is associated with an increased risk of suicide.23 If discontinuing the offending agent is not feasible, akathisia can be treated with beta blockers, benzodiazepines, or anticholinergics.24

 

23. Hirose S. The causes of underdiagnosing akathisia. Schizophr Bull. 2003;29(3):547–558.

24. Kane JM, Fleischhacker WW, Hansen L, et al. Akathisia: an updated review focusing on second-generation antipsychotics. J Clin Psychiatry. 2009;70(5):627–643.

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After rotating between all sots of meds for several years, including most of the atypical antipsychotics, in about 2009 I began to experience severe akathesia on Invega. Ended up in the ER twice because I was climbing the frickin walls.

 

Switched to abilify with same story. Switched to risperdal and it was slightly milder, so they called it "RLS" and treated it with more drugs (Miripex sent me on a spending spree, gabapentin seemed to make it bearable.) Haven't taken risperdal since around the beginning of the year. D/ced the gabapentin shortly after that and all was well in Akathesia land. Between then and June I tapered off of Lithium, Welbutran XL, and Clonodine.

 

Over the past week or so it's gradually been coming back. It's miserable, god it's miserable. It's especially strong in my legs though it's a pretty generalized "inner restlessness" most of the time. I'm having trouble sleeping or even sitting still to type this. Last night I sat in the living room suffering... tonight I'm gonna find something to clean or go for a walk or something.

 

Is there anything I can do?

 

The gabapentin use to help when it was caused by the risperdal... but I *really* don't wanna get back into this psych med thing. I don't even want to bring my self to the attention of the "mental health authority" at all. Additionally... I was under the impression that akathesia isn't exactly an organic kind of thing. It's a side effect of certain meds and only a side effect of certain meds. RLS is another debate from what I've read.

 

Could a withdrawal symptom like that show up a couple weeks after finishing all my tapers, even though during those weeks I didn't seem to experience much in the way of "withdrawal"? (Almost nothing physical. Mostly emotional stuff that didn't last long or get too awful compared to before.) It... will go away eventually though... right? Suggestions, experiences, anything... appreciated

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Hello again, Amanda.

 

Yes, akathisia is a recognized and very difficult withdrawal symptom.

 

People have various ways of coping with it. It does go away, but like the other symptoms, it can take quite a while.

 

I'll let those who've experienced it add their experiences and suggestions.

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Yes, akathisia is very much a drug-induced side-effect but also a WD induced symptom.

 

 

Amanda, I did have it quite severely for some time but it did eventually lessen in severity and it does completely remit at some point.

 

 

I wish I could offer a few non-drug options that would help but I was not able to find anything other than feverishly moving, pacing etc. As you know it's pretty impossible to keep still.

 

If I may, I'd like to share some things that made akathisia worse for me: Computer exposure and hot baths and/or showers. The hot bathing also made RLS (restless leg syndrome) worse as well.

 

The akathisia was also more extreme in the early part of the day. As the day progressed it would lessen in intensity (on it's own) however, in my case, it would become re-activated (although not as extreme as in the mornings but still distressing enough) when I was exposed to the computer and/or hot bath.

 

I had to bathe quickly and in warm water since, baths intensified many other symptoms as well. Showers were out of the question for me due to other WD issues.

 

Please keep in mind that I had incurred many extreme reactions to the computer and thus, my experience may not be applicable to others who suffer with akathisia. Although, it's impossible for me to be the only case out there who responded in this manner. (lol)

 

BTW, any medications used to treat RLS or akathisia can produce WD/rebound akathisia and RLS upon cessation, even if one has tapered.

 

I know how extremely distressing and even torturous this symptom can be but I promise you, this will eventually go away, as Alto mentioned.

 

So sorry you have to go through this type of suffering.

 

Much More Healing to You!

 

 

Punar

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HI Amanda,

 

I slow tapered, took me 56 months to get off paxil and i too had the akathedsia, its awful,

some days all you can do is pace and pace and cry - i know, and it seems to ramp up anxiety levels too.

 

It does get better , all you can do is do what you have to, and try to keep very busy, that will be easy for you, i know, when you cant sit still anyway.

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I had never heard the word Akathisia until I experienced this horrible demon and researched it a bit.

 

I would like to describe how it feels to me since taking Lexapro in 2006.

 

When it is at its most intense I can barely control myself physically. I had never ffelt anything like it before traking the SSRI in 2006. It is not nervousness or anxiety. It feels like an intense tickling sensation in my bones and muscles...mostly in my arms and legs but also in every part of my body. I want to bite my fingers because sometimes pain is a wonderful distraction. I pace and this helps. when it is very bad I want to scream and have done so at times. I feel like I am losing control and that my brain is being squeezed. the sensation can come in waves which increase or diminish over a period of time. Sometimes the sensations have lasted for days. I almost always have some sensation of this every day with only short periods of time on "those lucky days" where I can almost feel at ease.

 

The intensity is so great sometimes which offers a window of understang as to why a person might take action to end their life. I would describe akathisia as something as bad or worse than pain. Not knowing what is causing it or how to find relief makes this physical problem even more frustrating and scary. Out of all of the dozens of horrible sensations I have experienced due to my adverse reaction to Lexapro, akathisia is definitely the worst. It is like having poison ivy on the entire inside of my body and not being able to itch it.

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Hi Amanda. I've gone through a few bouts of the Akathisia a few times. The first time was when I had to stop Cymbalta suddenly for an emergency surgery. It lasted a couple of weeks then went away. I had it as a side effect on antipsychotics as well. Especially Geodon. So anyway, I haven't had it for many months now so it did go away for me, thank God. Hang in there.

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Hello,

 

I've been off of Effexor for at least six months, but am still having "creepy crawly" sensations all over my body. Lately it's been getting WORSE and really disrupting my sleep. I've read descriptions of Restless Legs Syndrome, and it kind of fits. I was recently told by a psychiatrist that Effexor can cause RLS, or make it worse. Could Effexor have caused this, and will it ever go away?

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Hello,

 

I've been off of Effexor for at least six months, but am still having "creepy crawly" sensations all over my body. Lately it's been getting WORSE and really disrupting my sleep. I've read descriptions of Restless Legs Syndrome, and it kind of fits. I was recently told by a psychiatrist that Effexor can cause RLS, or make it worse. Could Effexor have caused this, and will it ever go away?

 

Just FYI, it seems like somewhere around six months is a common time for AD withdrawal symptoms to ramp up even when the person has been doing pretty well for a while. I don't know why. Seems like "six months" is a number that just comes up a lot for people. This is the point when doctors usually diagnose a "relapse" and put people back on meds it seems like.

 

I don't have any solid stats on that, it's just an impression I've gotten from reading hundreds (thousands?) of posts on this board and other boards.

 

Anyway, yes, it WILL ever go away...hang in there! Just remember it's withdrawal.

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I posted a blog about my experience of akathisia and thought I'd post it here for the record as well, it seems there are numerous different experiences of akathisia which is why I was confused about it and whether it applied to my experience until I read "Prozac Panacea or Pandora" by Ann Blake Tracy

 

My experience of akathisia

 

....

Edited by Altostrata
removed duplicate post

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strawberry, your link works fine.

 

I deleted the duplicate post as it's also published in full in your topic here http://survivingantidepressants.org/index.php?/topic/556-hi-from-strawberry/page__view__findpost__p__14100

 

Thank you for posting this. Akathisia is an under-recognized adverse effect of psychiatric drugs and antidepressant withdrawal.

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OK thanks.

Well I only found out recently through reading the book and the anecdotes that actually what I was feeling was akathisia, only I didn't have the restless legs thing, but extreme internal turmoil.

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Right, you can get the internal feeling of akathisia without physical restlessness.

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It's hard to explain, it's internal adrenaline turmoil, which makes me physically restless because it's impossible to sleep and I was in a constant state of "fight or flight" if that makes sense.

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That's an excellent description of this awful symptom!

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I dunno if this really is akathisia - my nerves in my arms and legs feel like they are burning or tingling. Sometimes its bad enough that I have to keep moving my legs to find relief. It's not like RLS though.

 

Anyway, I discovered vitamin B6 may be helpful for akathisia. So I took 50mg (smallest dose they had) today and it really seemed to help! It also made me a bit drowsy, so I'm going to try taking it before bed from now on.

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I dunno if this really is akathisia - my nerves in my arms and legs feel like they are burning or tingling. Sometimes its bad enough that I have to keep moving my legs to find relief. It's not like RLS though.

 

Anyway, I discovered vitamin B6 may be helpful for akathisia. So I took 50mg (smallest dose they had) today and it really seemed to help! It also made me a bit drowsy, so I'm going to try taking it before bed from now on.

 

Your description is exactly what I have for RLS which include my arms but happen when I'm trying to sleep as opposed to during the day. I'm going to watch the B6 thing.. interesting.

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I dunno if this really is akathisia - my nerves in my arms and legs feel like they are burning or tingling. Sometimes its bad enough that I have to keep moving my legs to find relief. It's not like RLS though.

 

Anyway, I discovered vitamin B6 may be helpful for akathisia. So I took 50mg (smallest dose they had) today and it really seemed to help! It also made me a bit drowsy, so I'm going to try taking it before bed from now on.

 

Your description is exactly what I have for RLS which include my arms but happen when I'm trying to sleep as opposed to during the day. I'm going to watch the B6 thing.. interesting.

 

Interesting. When I was on mirtazapine I had what I thought was RLS. It felt like a compulsion to move my legs in bed. This is more like I'm moving my legs to get rid of the constant tingling.

it feels distinctively different to me.

 

I found a couple of studies that suggest B6 might help akathisia -

 

http://www.ncbi.nlm.nih.gov/pubmed/16614537

 

http://www.ncbi.nlm.nih.gov/pubmed/15554771

 

I also found some anecdotal reports. One person (on an antipsychotic) said he no longer had akathisia after his doctor prescribed 300mg B6 and 100mg P5P. That's a much higher dose than what I'm taking, but it's not unusual for me to only require small doses of medication and my nerves are sensitive from w/d.

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I dunno if this really is akathisia - my nerves in my arms and legs feel like they are burning or tingling. Sometimes its bad enough that I have to keep moving my legs to find relief. It's not like RLS though.

I don't get burning, only tingling. feel a compulsion to move because it gets rid of the tingling. Actually, the movements are more like writhing. Just curious, how is what you have now different from RLS?

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Be careful with vitamin B6, many sensitized people find it activating instead of soothing.

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