Akathisia – side effects of psychiatric drugs

Side effect of antipsychotic and antidepressant drugs

Akathisia can exist in patients as a neurological condition but has now become much more common as a result of taking antipsychotic and antidepressant (selective serotonin reuptake inhibitor – SSRI) drugs.

It can be defined as:

“Subjectively, akathisia may present with an inner restlessness that involves mainly the legs but can also involve the arms or trunk, a compulsion to move, dysphoria [feeling of discomfort or distress], anxiety, inner tension, and other less common symptoms such as rage, fear, nausea, or worsening of psychotic symptoms. Objectively, akathisia may present with fidgetiness of the hands, arms, and limbs, complex repetitive movements, persistent swinging and crossing and uncrossing of the legs, moving from foot to foot, walking, and pacing.”

Fernando Espi Forcen, Konstantina Matsoukas and Yesne Alici. Antipsychotic-induced akathisia in delirium: A systematic review. ¹

This video was produced by Aimee & Josh Jensen as an educational video regarding Josh’s akathisia and dystonia condition as a result of taking medication. Josh was given further drugs to handle the initial akathisia condition but these brought on dystonia (muscles contracting involuntarily causing repetitive twisting movements).

Psychiatry in DSM V defines two types of akathisia.

The first is medication-induced akathisia which results from starting or raising a medication dose or reducing other medication taken to handle involuntary movement symptoms.

The second is ‘tardive akathisia’ which can occur late in the course of treatment, usually three months after medicine or dose change, and which can go on for months or years even when no longer on medications or dosage reduction.

A 2017 paper on the state of the condition found very high rates of akathisia in various psychiatric treatment situations:

• Patients with schizophrenia were found with 24% having chronic akathisia and 18% “pseudoakathisia” [only having objective symptoms]
• For patients treated with clozapine, akathisia rates were 39%.
• For patients treated with first-generation antipsychotics, the rate was 45%.
• A study to determine the prevalence of global akathisia in a community-dwelling sample of patients with schizophrenia found rates of 15 to 35%.
• Bipolar I (manic depression) patients who were taking antidepressants will develop akathisia in 10 to 18% of cases.

Akathisia was first observed after the first antipsychotic chlorpromazine was first introduced in 1952. Despite it now being 70 years later psychiatry has no definitive idea of what causes akathisia.

Various attempts to handle the condition through lessening dosage, and changing medications may alleviate however there is no guarantee anything will work. Despite its appalling effects on patients, it is an area given little attention by psychiatry. ^{2 3 4}

Akathisia can result in violent behavior and reports of resulting homicidal tendencies exist. ^{5 6}

The subjective stresses produced can result in extreme anxiety and a depressed mood and risk of suicide, particularly through mis or no diagnosis of the condition. ⁷

The risk of akathisia with SSRI antidepressants was known and yet withheld for years until finally disclosed. For example, it was known that 3.5% of Prozac patients either attempted or committed suicide due to the stresses of akathisia.

At the time a Pfizer employee, Roger Lane, stated in a 1998 paper:

“It may be less of a question of patients experiencing fluoxetine-induced suicidal ideation than patients feeling that ‘death is a welcome result’ when the acutely discomforting symptoms of akathisia are experienced on top of already distressing disorders.”

Roger Lane. ⁸