Restlessness: Symptoms, Causes, Treatment, Cost, and Side Effects

Restlessness, also known as Akathisia, is a movement condition and neuropsychiatric illness that makes it difficult to sit quietly or stay still because of an underlying restlessness. Akathisia typically causes significant inner distress and inability to sit quietly due to ‘psychomotor restlessness’. The name of the condition derives from a Greek word ‘akathemi’, which itself tells a lot about the condition and literally means ‘never sit down’.

Although it can happen with more recent antipsychotic (neuroleptic) drugs as well, akathisia is linked to the side effect of older, first-generation antipsychotic medications used to treat mental health problems like schizophrenia and bipolar disorder. Between 20 and 75 percent of patients who take these medications experience this side effect, particularly in the initial weeks of therapy. A few medical conditions, such as Parkinson's disease, have also been linked to akathisia.

Based on when it begins, the ailment is classified into different types:

• Acute Akathisia: Shortly after you start taking the medication, acute akathisia appears and lasts for less than six months
• Tardive Akathisia: A few months or perhaps years after taking the medication, tardive akathisia sets in
• Chronic Akathisia: A chronic case of akathisia lasts for over a year
• Withdrawal Akathisia: This kind of Akathisia may appear if some drugs are stopped or their dosage is reduced

A person with akathisia feels a great deal of anxiety or restlessness inside. They feel the need to move as a response, usually with their lower limbs. The movement is typically repeated. The constant want to move can be extremely distressing.

Akathisia symptoms often occur right away after you begin taking antipsychotic (neuroleptic) drugs or right after your doctor increases your dosage. The patients have an irrepressible urge to move and a strong urge to move or feeling of restlessness. The primary sign of akathisia is a jittery or restless sensation, especially in their lower body from the hips to the ankles. The akathisia patient performs repeating motions like these to quell the urge:

• Crossing and uncrossing the legs or swinging one leg while sitting
• Lifting the feet as if marching
• Pacing
• Rocking back and forth while standing or sitting
• Shifting weight from one leg to the other
• Shuffling while walking
• Walking in place

Additional signs include:

• Stress or anxiety
• Irritability
• Impatience

The precise cause of akathisia is unknown, however several drugs that block dopamine receptors in the brain are thought to be the main cause behind it. Dopamine is a neurotransmitter that affects a variety of vital bodily processes, including movement.

Blocking eventually causes undesirable involuntary movements. Other neurotransmitters, such as acetylcholine, serotonin, and GABA, have, however, recently drawn attention as potentially contributing to this illness.

The movement disorder akathisia is the most typical one connected to antipsychotic drugs. This is sometimes referred to as antipsychotic-induced akathisia by healthcare professionals.

Neuroleptics, another name for antipsychotic drugs, can be divided into two groups:

• Antipsychotics of the first generation or 'typical' (FGA)
• Antipsychotics of the second generation or 'atypical' (SGA)

In comparison to SGA medications, the use of FGA medications, particularly with high-potency and high-dose, is more frequently associated with akathisia.

First and second generation antipsychotic are prescribed for a number of neuropsychiatric disorders, such as:

• Behavioral disturbances in dementia
• Bipolar disorder
• Depression
• Eating disorders
• Generalized anxiety disorder
• Insomnia
• Obsessive-compulsive disorder (OCD)
• Personality disorders
• Post-traumatic stress disorder (PTSD)
• Schizoaffective disorder
• Schizophrenia and related disorders

Akathisia is also linked to a number of health issues, such as:

• Encephalitis (brain inflammation)
• Harm to the brain from trauma (TBI)
• Parkinson's condition

The following medications may increase a user's risk of developing akathisia:

• Blockers of calcium channels
• Inhibitors of selective serotonin reuptake (ssris)
• Medication prior to surgery
• Medications for vertigo
• Medicines that prevent nausea

Antipsychotic medications such as these can cause the adverse effect of akathisia:

• Chlorpromazine (Thorazine)
• Flupenthixol (Fluanxol)
• Fluphenazine (Prolixin)
• Haloperidol (Haldol)
• Loxapine (Loxitane)
• Molindone (Moban)
• Pimozide (Orap)
• Prochlorperazine (Compro, Compazine)
• Thioridazine (Mellaril)
• Thiothixene (Navane)
• Trifluoperazine (Stelazine)

Akathisia can also be brought on by illicit substances including cocaine, methamphetamine, and amphetamine.

Though, there isn't a permanent cure for akathisia yet, your healthcare professional may treat medication-induced akathisia by changing your medication or, if necessary, reducing the dosage. Restlessness can also be treated or prevented by following measures;

• On priority consult your healthcare provider if you notice any symptoms
• Your treating doctor may manage the symptoms of your akathisia with the help of certain medicines
• A physician can quickly alter a patient's prescription and treat the akathisia's likely underlying cause
• To help with your condition take the prescribed medications on time
• Take care of your mental health
• Take proper rest
• Stay away from alcoholism, and also cut down the intake of caffeine and other substances that may interfere with your brain receptors, chemicals or hormones

• Don’t take any medication on your own, without the prescription of a health expert
• While taking antipsychotic always cautious of permitted dosage that your healthcare provider has mentioned never take more than the prescribed quantity as it may increase the chances of your akathisia
• Never start or stop antipsychotic drugs without the suggestion of a health expert
• Avoid or limit the consumption of caffeine and sweets as components found in these can contribute to a rise in excitability, which will heighten your akathisia symptoms
• Refined food items, including grains and oils, are also forbidden since they are likely to contain toxic additives or may have been depleted of nutritional value
• Avoid alcohol as well because it has been shown to disrupt one's hormonal balance

Clinical observation is frequently used by medical professionals to identify akathisia. Your doctor will inquire about your symptoms, medical history, and current medications if you believe you have akathisia in order to make a diagnosis. They'll also watch how you act and move.

Unfortunately, akathisia is frequently misdiagnosed since its symptoms frequently resemble or overlap those of other psychiatric disorders. Tests may be required to determine whether you have akathisia and not other disorder with similar symptoms, such as:

• Agitated depression
• A mood disorder
• Anxiety
• Attention-deficit/hyperactivity disorder (ADHD)
• Mania
• Psychosis
• Restless leg syndrome (RLS)
• Tardive dyskinesia
• Withdrawal from drugs

Physical examination

The most common clinical tool for evaluating akathisia is the Barnes Akathisia-Rating Scale (BARS), which is provided by healthcare professionals like doctors and nurse practitioners to gauge the severity of drug-induced akathisia.

On the basis of the sums of Objective Akathisia, Subjective Awareness of Restlessness and Subjective Distress Related to Restlessness' scores achieved, a healthcare provider can determine the patient's Barnes Akathisia Rating Scale's final score that can range from 0 to 9.

During each stage the patient is observed for his bodily movement or calmness and any signs of distress caused by the akathisia which characterize the condition.
Medical history

Your doctor may ask you about your current medications, and any other issues you may have. This will assist in excluding other illnesses that may result in comparable symptoms. The tests are frequently done to rule out the following conditions;

• Restless legs syndrome: Uncontrollable urges to move your legs are another symptom of restless legs syndrome, however they typically occur at night. Leg pain may also be an issue.
• Antipsychotic medication: Its adverse effects include tardive dyskinesia. It makes repetitive actions like blinking and grimacing happen. However, you have no control over them. When you have akathisia, you choose to move to sate an urge.
• Insomnia or anxiety: It's simple to confuse akathisia with these disorders because it causes you to feel anxious and restless.
• For other similar conditions: The symptoms of ADHD, agitated depression, mania, or psychosis are all comparable.

The symptoms of restlessness are easy to identify. You can check for the condition on your own by looking for movements like;

• Typically fidget and shift positions
• Legs are crossed and uncrossed
• When seated, rock back and forth with your feet
• Shuffle your legs

Or, you can also see if you have mental state that makes you seem;
Tensed

However, it is always advisable to consult a healthcare provider to check for your symptoms as akathisia is often confused with other health conditions.

Regularly move around, especially outside t o naturally improve your mood

Following the termination of antipsychotic or after the reduction of its dosage, withdrawal akathisia usually appears within two weeks and subsides on its own within six weeks. When akathisia lasts longer than 6 weeks, it should be classed as tardive akathisia rather than withdrawal akathisia.

As the condition mostly results in depression and anxiety among many other mental and emotional states, it is important to give the patient a healthy diet to elevate his/her mood and overall mental health to help with the akathisia symptoms;

Breakfast
For those who have akathisia, breakfast is crucial since it frequently has an impact on how your body produces hormones throughout the day. When you eat well, your body puts you in the best mood possibleDairy products that are raw are also beneficial. Try cooking your food in healthy fats like coconut oil if you are frying itEggs and beef are good sources of traditional breakfast protein, provided they are produced sustainably and without the use of hazardous hormones

Lunch
Foods high in vitamin B6 should make up a significant portion of your diet as they have been found to significantly improve the symptoms of akathisiaTurkey, meat, and carb-heavy foods like root vegetables are other lunchtime items high in this vitaminHigh-fiber foods can also aid in cleansing your digestive system, removing contaminants and facilitating quicker nutritional absorption

Snacks
Healthy snacks for persons with akathisia include nuts and seeds. Because they include a balanced array of nutrients, beans and legumes make excellent snacksChia and flax seeds are also recommended if you are interested in healthy foods. These work well with other meals, too. If you're looking for a portable snack, stick to peanuts that have been cooked in coconut oilAnother dietary item high in Vitamin B6 is fortified tofu, which pairs well in a skillet with lentils and a little meat

Dinner
Since fish is a rich source of protein as well, it makes a tasty dinner option. Salmon or other wild-caught fish may help your symptoms get betterBrown rice is a good example of a carbohydrate source that you may add to your diet to add more minerals and help you get more vitamin B6

Drinks
Although there are no specific drinks that are advised for akathisia, beverages high in vitamin B6 are the bestFruit drinks are fantastic, but since banana smoothies and avocado shakes are high in vitamin B, you can also choose those over fruit juicesHormones can be stabilized by drinking a coconut milk shake, which is also a refreshing beverage on hot days

Herbs
An organized group of herbs known as 'adaptogenics' helps to control the body's hormonal reactions while minimizing the consequences of stress. These are typically effective in treating anxiety-related symptoms including akathisiaRhodiola and ginseng are two of the most popular adaptogenic herbs. Despite not being used in cooking, these herbs frequently come in a variety of additional forms (capsules, concentrates, etc.)The plant St. John's Wort is another well-known antidepressant. This is also fantastic for getting decent sleep, as the symptoms of the illness can be very disruptive in this area

Fruits
Fruits like coconuts, bananas, avocados are excellent for those with akathisiaAlso, jackfruits, passion fruits, melons, elderberries, apples, mangoes and dried prunes are some of the healthy food options.

A patient with restlessness or akathisia should avoid caffeine and sugar in particular. Take only a limited amount of them if you must. These two food components can help raise excitability, which in turn raises your symptoms:

• Refined food items, including grains and oils, are also not allowed since they are more likely to contain toxic additives or to have had vital nutrients removed
• Avoiding alcohol will also help you maintain a healthy hormonal balance.

If an antipsychotic produced the akathisia, treatment may involve switching to an antipsychotic with a lower risk of the condition. Your treating doctor may manage the symptoms of your akathisia with the help of certain medicines, that may include;

• Propranolol (a beta-blocker)
• Benzodiazepines (a class of drugs commonly used to treat conditions such as anxiety, insomnia and seizures).
• Low-dose fluoxetine (an antidepressant)
• Anticholinergics (medications often used to treat asthma and other diseases)
• B6 vitamin

Going to urgent care for restlessness or akathisia may be beneficial, especially if you are worried that your symptoms indicate a medical emergency.

There are many causes and acute symptoms of restlessness that can be treated with medication or by limiting and modifying the dosage of the patient's antipsychotic drugs.

By seeking treatment from an expert such as a psychiatrist, doctor, nurse practitioner or a therapist, you can prevent the need for emergency care in the future.

Physical symptoms of anxiety can include any of the following:

• Anxiety and ‘mental discomfort’
• Irritability
• Impatience
• Signs of ‘insanity’ and psychotic disorders getting worse
• Repeatedly pacing, compulsions, inability to sit still, and need to move all the time
• Rocking back and forth while standing or sitting
• Persistent fidgeting
• Shuffling while walking
• Walking in place
• Swinging or crossing the legs
• Shifting positions
• Rage, agitation, and anger
• Disruptions in behavior often referred to as akathisia-induced impulsivity
• Depression, anxiety, and in certain circumstances, suicidal thoughts or actions symptoms
• Fear, trepidation, and an overall 'feeling of dread'
• Difficulty sleeping
• Nausea, appetite loss, and occasionally weight loss
• Slow thinking

Some of the aforementioned signs and symptoms may also point to other mental conditions. Medical emergencies can arise with other illnesses, and akathisia can be one of them left untreated or advanced to tardive akathisia. Seek medical attention if you are worried that your symptoms are the result of a medical condition.

A psychiatrist is the best medical care professional to treat mental health problems like akathisia. Anyone on a new antipsychotic or other drug who develops side effects needs to see a doctor right away to alter their medication. A physician can quickly alter a patient's prescription and treat the akathisia's likely underlying cause. Patients with chronic akathisia may be started on daily medication. Akathisia might exacerbate the underlying disease that is producing the psychotic behavior if it is not treated. Untreated akathisia patients frequently quit taking the medications required to manage their mental diseases, which results in uncontrolled mental illnesses.

Following are the best known medicines to treat akathisia;

• Beta-blockers like propranolol
• Benzodiazepines
• Anticholinergics
• Certain antidepressants, like mirtazapine or trazodone
• Drugs for Parkinson’s disease, like amantadine
• Vitamin B6

Restlessness or akathisia can be treated with the help of certain lifestyle modifications and medicines like beta-blockers, benzodiazepines, anticholinergics, certain antidepressants, and Vitamin B6.

There is no surgical treatment for akathisia. The condition can itself go away within 6 months if it was caused due to the withdrawal of a particular drug(s) or may also be managed and treated by a number of medicines.

Restlessness or akathisia is the uncomfortable feeling of internal restlessness that may raise the risk of suicide on its own. The condition doesn’t require a surgical procedure but could be cured by a number of medicines and lifestyle modifications.

Treating restlessness or akathisia in India, is very simple, affordable, and cost-effective with a high success rate.

Acute akathisia manifests right after you start taking a drug and doesn't last more than six months. However, chronic akathisia lasts six months or more. Tardive akathisia may emerge soon after the patient stops the medicine causing the symptoms and may not go away for several months, or it may become permanent.

The condition known as ‘withdrawal akathisia’ may also worsen temporarily after the drug producing the symptoms is stopped.

It's critical to seek treatment for akathisia as soon as possible. If left untreated, it can exacerbate psychotic behavior. You might also be unable to take the medication you require to treat a mental disorder because of this disease. There are also some instances where akathisia sufferers engaged in aggressive or suicidal actions.

There isn't a permanent cure for akathisia yet. Your healthcare professional may treat medication-induced akathisia by changing your medication or, if necessary, reducing the dosage.

• Lead a healthy and active life
• Eat a balanced diet
• Do meditation, yoga and breathing exercises
• Stay in touch with nature
• Do your favorite activities that makes your feel happy
• Keep on taking the recommended dosage of your prescribed medicines
• Don't stop your medicinal course without the knowledge of your healthcare provider
• Always talk to a friend or a close one if you feel agitated or any emotional distress.

As sleeplessness and hyperactivity is one of the main causes of akathisia or restlessness, calming medicines are generally administered to the patient, which may result in inactiveness and sluggishness.

Akathisia or restlessness is generally the side effects of antidepressants, anti-hypertensives, anticonvulsants, antipsychotic, antibiotic or preoperative sedatives among several other medicines, resulting in inner distress and, occasionally, ‘psychomotor restlessness’ which makes it impossible to sit quietly for the patient. It is always advisable to consult a health expert to evaluate, manage and treat the symptoms of akathisia as the patient of akathisia may also exhibit violent behavior and suicidal thoughts.