Akathisia is an extremely distressing neurological disorder that is most often a medication side effect or withdrawal syndrome. It is characterized by severe agitation, an inability to remain still, and an overwhelming sense of terror, and it is so torturous that it can lead to impulsive suicide and violence.
Please watch this 1-minute video to better understand the severity of akathisia.1
- “Akathisia is generally either underdiagnosed or misdiagnosed, which is a serious problem because it can lead to such adverse outcomes as poor adherence to medications, exacerbation of psychiatric symptoms, and, in some cases, aggression, violence, and suicide” (Lohr, et al., 2015).2
- “Akathisia is likely underdiagnosed because its symptoms often mimic or overlap psychiatric disorders like psychosis, mania, attention deficit hyperactivity disorder, or agitated depression” (Patel, Marwaha, 2022).3
- “Psychiatric drugs were used by the Soviet Union in the Gulag to induce akathisia as a form of torture” (Glenmullen, Akathisia Alliance, 2019).4
- Dismissal of a self-diagnosis with subsequent administration of a contraindicated medication, acceleration of a tapering rate, or abrupt discontinuation of a psychotropic medication could severely exacerbate akathisia.
Medications That Can Cause or Worsen Akathisia
Benzodiazepines and Akathisia
Although there is little peer-reviewed literature regarding akathisia in benzodiazepine withdrawal, there are thousands of support group members with akathisia due abrupt discontinuation or rapid tapering, the majority of whom had taken the medication as prescribed.
It is well known in the support groups that benzodiazepine interdose or end-of-dose akathisia is very common in dependent individuals. In this case, patients taking benzodiazepines who appear agitated while demanding this medication may only appear to be drug-seeking because they are attempting to ward off escalating akathisia.
1. Akathisia Alliance for Education and Research. (2022, December 7). Drug-Induced Akathisia is a Suicide-Prevention Emergency [Video]. YouTube. https://www.youtube.com/watch?v=dDpr-FRRdFA
2. Lohr JB, Eidt CA, Abdulrazzaq Alfaraj A, Soliman MA. The clinical challenges of akathisia. CNS Spectr. 2015 Dec;20 Suppl 1:1-14; quiz 15-6. doi: 10.1017/S1092852915000838. PMID: 26683525.
3. Patel J, Marwaha R. Akathisia. 2022 Jul 25. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 30137828.
4. Akathisia Alliance for Education and Research. (2019e, August 26). Akathisia is Torture [Video]. YouTube. https://www.youtube.com/watch?v=_6eix3cdwoU
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11. Riesselman A, El-Mallakh RS. Akathisia with azithromycin. Ann Pharmacother. 2015 May;49(5):609. doi: 10.1177/1060028015570728. PMID: 25870444.
12. Healy, D. (2021, November 22). Mentally Hijacked by Doxycycline RxISK. https://rxisk.org/mentally-hijacked-by-doxycyline/
13. Demir B, Sancaktar M, Altindag A. Lithium-Induced Treatment-Resistant Akathisia: A Case Report and Literature Overview. Clin Neuropharmacol. 2021 May-Jun 01;44(3):112-113. doi: 10.1097/WNF.0000000000000453. PMID: 33811193.
14. Tuccori M, Lombardo G, Lapi F, Vannacci A, Blandizzi C, Del Tacca M. Gabapentin-induced severe myopathy. Ann Pharmacother. 2007 Jul;41(7):1301-5. doi: 10.1345/aph.1K077. Epub 2007 Jun 12. PMID: 17565043.
15. Rissardo JP, Caprara ALF. Pregabalin-associated movement disorders: A literature review. Brain Circ. 2020 Jun 26;6(2):96-106. doi: 10.4103/bc.bc_57_19. PMID: 33033779; PMCID: PMC7511912
16. Lohr JB, Eidt CA, Abdulrazzaq Alfaraj A, Soliman MA. The clinical challenges of akathisia. CNS Spectr. 2015 Dec;20 Suppl 1:1-14; quiz 15-6. doi: 10.1017/S1092852915000838. PMID: 26683525.