Akathisia: How to Spot It and What to Do

Have you ever felt an unbearable need to move after starting a medication? That inner restlessness — pacing, fidgeting, or not being able to sit — can be akathisia. It’s a real, often drug-related condition that people sometimes mistake for anxiety. Knowing the signs and quick steps to take can make a big difference.

What causes akathisia?

Most often, akathisia shows up after starting or raising the dose of certain drugs. The main culprits are antipsychotics (especially older ones like haloperidol), some anti-nausea meds (metoclopramide), and in some people, antidepressants (SSRIs) or withdrawal from them. Timing varies: it can appear within days (acute), weeks (subacute), or even months (tardive akathisia).

Risk factors include higher doses, rapid dose changes, being female, and a past history of movement side effects. Doctors sometimes use a short scale, the Barnes Akathisia Scale, to measure severity, but you don’t need that to notice the problem — if you feel physically restless and uncomfortable, speak up.

What to do if you suspect akathisia

First: don’t stop your medication suddenly. Abruptly stopping some drugs can be dangerous. Instead, call your prescriber and describe specific symptoms — when they started, how intense they are, and whether they get better or worse with activity or time of day.

Clinicians commonly try a few options: lowering the dose, switching to a different drug, or adding a medicine to reduce symptoms. Propranolol (a beta-blocker) often helps. Short-term benzodiazepines (like clonazepam) or anticholinergic drugs (like benztropine) can also reduce restlessness for some people. For antidepressant-related akathisia, switching medications or adding mirtazapine is sometimes used. Your doctor will pick the safest choice for your situation.

If you’re feeling hopeless or having suicidal thoughts, treat it as an emergency. Akathisia can be intensely distressing and increase the risk of self-harm. Contact emergency services or a crisis line right away.

A few tips to make life easier while you wait for a plan: try paced activity (short walks), calming breathing exercises, and cooling showers. These won’t fix the cause but can reduce discomfort. Keep a brief symptom diary — note times, severity, and triggers — so your prescriber has clear details.

Finally, prevention matters. If you or someone in your family has reacted badly to certain drugs before, tell the prescriber. Ask about starting at a low dose and regular check-ins during the early weeks of a new medication. Early recognition makes treatment simpler and keeps you safer.

If you’re unsure whether your restlessness is akathisia or something else (anxiety, restless legs, withdrawal), a quick call to your healthcare provider clears things up. You don’t have to live with that constant, restless feeling — help is available.