Akathisia and Benzodiazepines - for Clinicians, Family, and Friends
Benzodiazepines are currently being prescribed at an alarming rate for a variety of illnesses, including anxiety, panic disorder, nerve pain, seizures, “medically unexplained neurological symptoms,” etc. In fact, Xanax (alprazolam), Ativan (lorazepam), Klonopin (clonazepam), and Valium (diazepam) were among the top 100 most widely prescribed medications in 2018 (Fuentes, Pineda, et al., 2018) .
Unfortunately, physical dependence to benzodiazepines can occur after even a few days and withdrawal often causes akathisia . In addition, people taking benzodiazepines can develop akathisia as each dose wears off (“interdose” or “end-of-dose” akathisia), which may become unrelenting when tolerance occurs. This is a well-known fact in support groups; however, many clinicians are not aware of it.
How can misdiagnosis increase the risk of suicide?
Misdiagnosing a patient physically dependent on benzodiazepines as an addict can cause significant harm. The following is a fairly common scenario. It begins when a patient is prescribed a benzodiazepine for anxiety, nerve pain, etc. Tolerance occurs and they develop withdrawal symptoms, including akathisia with suicidality. The doctor fails to recognize the akathisia, but increases the dose to alleviate its symptoms. This may happen several times. Although the patient takes the medication as prescribed, the doctor begins to suspect an addiction and begins treating the patient accordingly. Knowing the akathisia and suicidality will become much worse without the benzodiazepine, the patient strongly resists discontinuing it – further cementing their “drug addict” label.
The patient then loses the support of their family due to their “drug problem” and refusal to follow the doctor’s orders. Sadly, it is also common for these people to lose their friends, their job, their home, etc. While family and friends see this as hitting rock bottom due to a drug problem, it is actually the perfect recipe for suicide.
The story below was posted by a support group member who was prescribed a benzodiazepine for akathisia that was misdiagnosed as anxiety. He took it as prescribed. When tolerance set in, the akathisia and suicidality became much worse. His dose was raised, he was labeled a drug addict, and then this happened —
I was put in a god awful drug treatment center. They cold-turkeyed me off my benzo I was taking for akathisia and off trazodone which I’ve been on for many years. Needless to say akathisia got worse. After over a week of sleeping hardly at all I went completely berserk and was having a total meltdown. I started begging for an ambulance for a couple of days. They refused and wouldn’t let me speak to family even. Every time I mentioned the word akathisia they got angry and denied it even existed- Eventually they said I was an entitled little piece of shit and showing drug seeking behavior- threatened to beat me up- I begged for an ambulance- they called the sheriff and had me admitted to a psych hospital – transported me handcuffed and shackled three hours away to a horrible facility where I begged for help and they forced injections of haldol and geodon on me – causing me horrific tardive dyskinesia almost immediately. I wish that any of this story was not true.
Cold Turkey Benzodiazepine Withdrawal
There is a high risk of akathisia if benzodiazepines are discontinued abruptly, especially after long-term use. Unfortunately, many doctors today are either refusing to renew prescriptions or tapering their patients too rapidly due to the crackdown on prescription drug abuse. Stephanie and Christine illustrate the dangers of this practice in the video below —
Benzodiazepines and Akathisia - Raising Awareness
Dr. Jordan Peterson is a well-known clinical psychologist, professor of psychology at the University of Toronto, and best-selling author of 12 Rules for Life: An Antidote for Chaos. In 2019, he mysteriously disappeared from the public eye. His daughter, Mikhaila, explained what happened to him in a video released on social media six months later.
Jordan had taken a benzodiazepine as prescribed for several years and then developed akathisia. The benzodiazepine was discontinued abruptly which caused severe worsening of his condition. During a followup video podcast, Mikhaila and Jordan further detailed his story and warned of the dangers of benzodiazepines. This is a condensed version of that podcast —
Additional information about the dangers of benzodiazepines and the benzodiazepine withdrawal syndrome (BWS) can be found on the websites of the Benzodiazepine Information Coalition and The Alliance for Benzodiazepine Best Practices.
- Fuentes, A., Pineda, M., & Venkata, K. (2018). Comprehension of Top 200 Prescribed Drugs in the US as a Resource for Pharmacy Teaching, Training and Practice. Pharmacy, 6(2), 43.
- Johnson, J. (2020). What happens when you stop taking benzodiazepines? Medical News Today, April 9, 2020