Akathisia

by Phil on June 18, 2013

Melissa, a commenter on a recent post, asked if I would do a post on akathisia.

Akathisia literally means inability to sit.  People with this problem typically pace for long periods, and if they do sit down, they continue to keep moving and shifting their position in the chair.

In severity it can range from a generalized sense of uneasiness or agitation, to severe discomfort and even pain.  The discomfort tends to be located in the legs, but can also occur in the hip and pelvic area.  In severe cases, the victims pace to the point of exhaustion, but even then sitting does not relieve the discomfort.

CAUSE

The major cause of akathisia is the ingestion of neuroleptics and other drugs, including SSRIs and other antidepressants.

Akathisia also occurs in withdrawal from benzodiazepines (e.g. Valium, Xanax, etc.), opiates, and amphetamines.

TREATMENT

Akathisia is usually treated symptomatically with propranolol (Inderal), a beta-blocker widely used to treat high blood pressure.  Possible side effects include: congestive heart failure, insomnia, hallucinations, short-term memory loss, etc…

Benzodiazepines are sometimes used in the management of akathisia, but this, of course, can precipitate further problems on withdrawal.

Akathisia often stops when the drugs are discontinued, but in some cases can persist even years after the drugs are stopped.

Neuroleptic-induced akathisia is listed in DSM-IV-TR (under medication-induced movement disorders).  DSM states that “Akathisia may be associated with dysphoria, irritability, aggression or suicide attempts.” (p 801). [emphasis added]

It is widely maintained that akathisia is the “mechanism” linking SSRI’s with suicide and violence.  See, for instance, SSRI-Induced Akathisia’s Link To Suicide and Violence, by Evelyn Pringle.

It is not possible to communicate the profound horror of severe akathisia in a brief post such as this.  In the late 80’s, I worked for a while at a publicly-funded substance abuse unit in an Eastern state.  The unit was on the grounds of a state hospital, but was separate from the hospital physically and administratively.

During my lunch hour, I often walked in the grounds, and most days I encountered Betty (not her real name).  She had been resident at the hospital for years, and had extreme tardive dyskinesia and akathisia.  She was about 50, but looked more like 70.  She walked the grounds constantly in almost all weathers.  We would stop and chat, though her tardive dyskinesia made her speech almost unintelligible.  But even while she was stopped, she continued to pace on the spot.  She literally couldn’t stop.  And after a few minutes, she would move on.

I used to wonder what possible benefit outweighed the dreadful damage that had been done to this woman.  What risk had she posed to herself or to others that justified reducing her to this state of perpetual torment?

Sometimes I get tired of writing these posts; tired of sifting through the facile lies of psychiatric complacency; tired of reading about psychiatry’s fat cats wallowing in the corrupting bounty of pharma money.  And then, I remember Betty.  Poor old Betty, living as best she could in her psychiatry-fabricated Hell.

If you’ve never seen a person suffering from akathisia, there’s a video here.

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  • Cledwyn B’stard

    Thanks for this post. I’ve experienced this before, but all of a sudden, after years of taking the drugs, it’s come back, and it’s just the worse torture I have ever experienced, along with dystonia. I hope these beta blockers work, because I’ve been taking way too much lorazepam recently. Life isn’t worth living when you feel like this.

    When I was in one of these “hospitals”, I knew someone exactly like the person you mentioned in the post. She’d been on neuroleptics for years, and she lived in perpetual torment, yet it was all dismissed as part of her disease. Yet they treated her as a nuisance.

  • Phil_Hickey

    Cledwyn,

    Sorry to hear about the akathisia. I hope you manage to get some relief.

    “Yet they treated her as a nuisance.” I can believe it!

  • Francesca Allan

    Cledwyn, I had no idea you were dealing with this. I’m very sorry. That video was unbearable — I couldn’t watch to the end.

  • Cledwyn B’stard

    Thanks.

  • Cledwyn B’stard

    Thanks. It really is horrendous.

  • Beth Leight Ricketts

    My daughter has akathisia and she is 7. She is supposed to start 2nd grade and I am scared I have no clue how to help her

  • Phil_Hickey

    Beth,

    I am truly sorry to hear this. Tragically more and more young children will share your daughter’s plight as pharma-psychiatry promotes its products to this age group.

  • Cledwyn Raging Bulbs

    Brutalitarian. I offer you my sincerest condolences, because I’m going through chronic akathisia, and I wouldn’t even wish this on these psychiatrists using the kindergarten as a recruiting ground for human sacrifices and experimental subjects.

    The only way to help her is to discontinue the drugs. Simple. Apart from that, the doctors you go to for help will just throw other toxins at you, like in my country procyclidine, which is nasty, and in america, beta-blockers. And you’ll get no compassion from these people most likely, because they are a bunch of typically solipsistic bourgeois ignorami with no direct experience of the kind of suffering they cause by prescribing these drugs, without proper disclosure of what has been known for a long time (and often forcing, as was the case with me, people to take them sometimes for so long that coming off them is not really an option, so that you just have to live with chronic akathisia, in a world where no-one, apart from your fellow akathisiacs, has the slightest idea of the enormity of what you are undergoing).

    Don’t expect any help from the bastards who put your daughter on these drugs, because of the mechanized denial amongst the proponents and practitioners of institutional psychiatry. The profession has no interest; it is utterly self-serving. If these people were to have an honest reckoning with the suffering they are causing and have been causing for hundreds of years, they’d end up like Lady Macbeth, so they just withdraw deeper and deeper into their own fantasies, acting like we don’t exist, and sacrificing more and more lives in maintenance of their outrageous fantasies, just so that the bad can sleep well, aided and abetted by the fact that most of the critics offer only diluted criticisms of this one of the great institutional evils in human history, this Moloch in medical garb, which cannot be denounced vehemently enough.

    The profession is a Trojan horse, an enemy in the midst of suffering humanity, that gains entrance to our trust and our hearts through deceptive means, only to destroy us. It is no more consecrated to the amelioration of human suffering than the Inquisition was to fighting evil.

    State psychiatry is a mala fide medical profession, a deception operating on such a large scale, even the deceivers are being deceived.

    It is fraud par excellence. In the world of psychiatry, you would do well to infer from what is said the polar opposite.

    The state psychiatrist is a doctor manque, a cowboy.

    Coming back to your daughter, it all depends really on how long your daughter has been on them. The big problem is for those of us who are trapped in this nightmare, for whom chronic akathisia is now an ineluctable part of our experience. If your daughter can easily come off them, then cessation of the “medication” should solve the problem.

    Nevertheless, direct experience of suffering at the hands of your species is one of the channels through which one can achieve moral salvation, so for this at least I am for chronic akathisia. It has really opened my eyes.

    Suffering at the hands of your fellow man affords insight into the depravity that has taken up permanent residence in the heart of man, a depravity that, for most people in our society, remains obscured from view;

    -because of the sheltered lives most men lead.

    -because of ethnocentric attachment to one’s own society that precludes honest appraisal of its institutions, customs, laws and values. –

    -because habit blinds us to the truth about the here and now (men are too used to and too personally implicated in their own age to see it clearly)

    -because of institutionalized denialism regarding human suffering within the culture.

    -because of those other inertial forces in human societies, those forces that retard progress, such as prepossession in favour of the familiar, man’s absolute terror of change, under whose influence his approval of atrocity is extorted (as long as the atrocity is familiar and supported by custom and convention, it won’t fail to find advocates from amongst the masses, whose minds operate perpetually under habit’s and custom’s thrall).

    -because complicity in evil, or a stake in its reign.

  • DG

    I experience this now every time I withdraw from opiates. My theory is like many psychoactive drugs, when someone moves from addiction to dependence, over time, after going through kindling type effects from opiate or other withdrawals, dysphoria, restlessness, leads to feelings or symptoms that are extremely similar to what one goes through during neuroleptic induced akathisia. Whether withdrawal from opiates are defined as specifically akathisia, or possess similar symptoms to what one goes through during acute type akathisia, doesn’t matter. The feeling is absolutely horrific, and the worst of all the symptoms(which has caused me to relapse to given opiate from not being able to stand three four days of hell before it eventually would ease up)
    Suggestions-clonazepam in particular used with inderal is great to ease the restlessness both subjective and objective. Only use for when symptoms exists, at most a week. Benedryl if one does not have clonazepam can be tried, but restless legs can be worsened especially during the worst of the acute stage of opiate withdrawal.
    even stopping adderall after chronic use, gives sensations of inner restlessness, but I believe that is more agitation type symptoms. Lorazepam helps with that specific kind of agitation.

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