Akathisia:when you can't sit still on medication

What does akathisia feel like?

Akathisia is mostly something you feel rather than something others see. The restlessness seems to come from inside the body, and moving brings only brief relief. It can make ordinary things, like sitting through a meal, a film or an appointment, feel almost impossible.

People often find it hard to put into words. These are some of the ways people describe it:

• Restless inside, as if the body will not switch off
• Feeling like I am crawling out of my skin
• A constant urge to move my legs, or to get up and walk
• Jittery, or like my body is vibrating
• Unable to settle, even when I am exhausted

Other people may notice shifting weight from foot to foot, pacing, rocking, crossing and uncrossing the legs, or standing up and sitting down again. Many people have never heard the word akathisia before they feel it, and some say nobody warned them about it. That is common, and it is not something you have done wrong.

What causes akathisia?

Akathisia is most often linked to antipsychotic medications that block dopamine, a chemical messenger that helps control movement. It can also happen with some antidepressants, including the group known as SSRIs, so it is not only a side effect of antipsychotics.

It is more likely soon after starting a medicine, after a dose increase, or when switching from one medicine to another. The exact mechanism is not fully understood, and the chance of akathisia differs between individual medicines.

When does akathisia start, and how long does it last?

Akathisia usually begins within the first days to weeks of starting a medicine or changing its dose. For many people it eases once their doctor adjusts the medicine or the plan around it. How long it lasts differs from person to person, and in less common cases it can continue for longer.

Because timing matters, it helps to note the date the restlessness started and any medication changes around then.

Is it akathisia or anxiety?

Akathisia and anxiety can feel similar, and they can happen at the same time, which is why akathisia is sometimes mistaken for anxiety. A few differences can help you describe what you are feeling:

• Akathisia is strongly physical: an urge to move, often felt in the legs, that can be there even when your mind feels calm.
• Anxiety tends to centre on worry, racing thoughts or a sense of dread, and the restlessness follows from that.
• Akathisia often starts soon after a medicine is started or its dose is changed.

Only a clinician can tell them apart, so describe both the physical feeling and your thoughts, and mention any recent medication change.

What is the difference between akathisia and restless legs syndrome?

Restless legs syndrome usually brings uncomfortable sensations in the legs in the evening or at night, especially when lying down, and moving the legs eases it. Akathisia can happen at any time of day, is felt more as a whole-body inner restlessness, and is often linked to starting or changing a medication. Akathisia is sometimes mislabelled as restless legs, so telling your doctor when it happens and when it began is useful.

How do I describe akathisia to my doctor?

Plain, specific descriptions help most. You do not need to use the word akathisia, although it is fine to ask about it. Try to cover:

• When the restlessness started, and whether a medicine or dose changed around then
• What it feels like in your own words, and where in your body you feel it
• What time of day it happens and how long it lasts
• What you can no longer sit through, such as a meal, a film or a conversation
• How it is affecting your sleep and your mood
• What other people have noticed, such as pacing or fidgeting

For example: "Since my dose went up two weeks ago, I have felt restless inside most of the day and I cannot sit through dinner." A short daily record makes this much easier to say clearly.

Should I stop my medication if I notice akathisia?

No. Do not stop or change a medication on your own, even if you think it is causing akathisia. Stopping suddenly can bring back the symptoms the medicine was prescribed for, or cause other effects. Contact your doctor or care team, tell them what you have noticed, and decide on next steps together. Movement side effects are well recognised, and there are usually options to talk through.

How to keep track of akathisia with EPSpeak

EPSpeak lets you log your medications and dose changes, complete a short daily check-in, and note restlessness in your own words on the days it happens. Over days and weeks, that builds into a history you can look back over, so the timing of a change is easy to see.

You can share your record with a clinician you choose using a QR code. EPSpeak does not diagnose akathisia and cannot tell you whether a medicine is causing it. It gives you and your doctor a clearer picture to talk through.