Akathisia is a restlessness so intense its name means 'cannot sit'
Some medicines, above all older antipsychotics, can leave people with an unbearable inner urge to move: pacing, rocking, shifting from foot to foot, then needing to sit, then needing to walk again. Because it looks like agitation, doctors sometimes respond with more of the very drug responsible, making things worse.
The word comes from Ancient Greek for 'not' and 'to sit'. Czech neuropsychiatrist Ladislav Haškovec described the phenomenon in 1901, decades before antipsychotics existed, and it had also been noted in Parkinson's disease. Drug-induced cases were reported with chlorpromazine in 1954 and with related phenothiazines by 1960. Today it is usually classed as a medication-induced movement disorder, though it can be purely an inner experience with little visible movement.
Blocking dopamine receptors is thought to be central, yet the biology remains poorly understood, and raised norepinephrine appears to be involved as well. First-generation antipsychotics are the leading cause, affecting about one in four patients who take them; newer drugs carry a lower risk, and a 2015 French study of outpatients with schizophrenia found a prevalence of 18.5 per cent. Antidepressants of the SSRI type, the anti-nausea drug metoclopramide, some calcium channel blockers and withdrawal from certain drugs can also trigger it.
What sets akathisia apart is the subjective feeling of tension, not the movement itself. Mania, agitated depression and ADHD can look similar, but those movements feel voluntary. Writer Jack Henry Abbott described in 1981 aching with restlessness, starting to pace, then feeling he must rest, with no relief either way. The Barnes Akathisia Scale rates both what patients feel and what observers see, though telling it apart from anxiety, insomnia or restless legs syndrome remains tricky. Clinical trial reports have sometimes logged it under vaguer labels such as agitation.
Recognition matters because severe, unrecognised cases can erode willingness to take medication and have been linked to aggression and suicidal thoughts, although that evidence rests largely on case reports and small series. It usually fades quickly once the causative drug is reduced, but a late-onset form can persist for months or years. Propranolol, low-dose mirtazapine and several other drugs have shown benefit, though some of them can paradoxically cause akathisia too.
Source: Akathisia
