Akathisia: what it is, what it feels like and why it matters
Akathisia is a severe and sometimes overwhelming state of inner restlessness that can occur as an adverse effect of medication, including antidepressants and other psychiatric drugs.
It can appear after starting a medication, changing the dose or, in some cases, reducing or stopping medication.
People experiencing akathisia may feel compelled to move constantly, pace or rock, but the visible restlessness is only part of the condition. Sufferers can describe extraordinary internal distress, agitation, panic or terror.
Akathisia can be mistaken for anxiety, worsening depression or another mental health condition. Recognising the possibility of a medication-induced reaction is therefore extremely important.
On this page:
What is akathisia? | Symptoms | What causes it? | Akathisia and antidepressants | Akathisia or anxiety? | Akathisia and suicide | Withdrawal | Real stories | Research and resources | Getting help
The Risks: Akathisia
Akathisia and antidepressants
Akathisia is a recognised potential adverse effect of antidepressants, including selective serotonin reuptake inhibitors (SSRIs).
The MHRA states that SSRIs can produce an uncomfortable sensation of tension, restlessness or anxiety and specifically identifies akathisia as restlessness accompanied by an inability to sit or stand still.
Akathisia has been reported in association with antidepressants including:
Sertraline (Lustral/Zoloft)
Fluoxetine (Prozac)
Citalopram (Cipramil/Celexa)
Escitalopram (Cipralex/Lexapro)
Paroxetine (Seroxat/Paxil)
Venlafaxine (Effexor)
Duloxetine (Cymbalta)
Mirtazapine
The fact that someone experiences agitation after beginning an antidepressant does not necessarily mean that their underlying mental health condition is getting worse.
The possibility of an adverse drug reaction should also be considered.
Why can akathisia be missed?
Akathisia can resemble symptoms of a psychiatric condition.
A person who becomes extremely restless after beginning an antidepressant, for example, may be told that their anxiety has worsened.
Insomnia may be attributed to depression. Agitation may be interpreted as part of someone's original illness. New suicidal thoughts may similarly be assumed to be evidence that depression is deteriorating.
This creates the possibility of what is sometimes called diagnostic overshadowing, where a medication-induced symptom is attributed to an underlying psychiatric condition.
Recognising the timing of symptoms in relation to medication can therefore be extremely important.
Akathisia can easily be mistaken for anxiety because the two conditions can share symptoms such as agitation, fear and an inability to relax.
There can, however, be important clues.
Someone with anxiety may feel worried, frightened or physically tense. Someone experiencing akathisia may describe an intense physical compulsion to move or an unbearable sensation of internal restlessness.
Timing may also be significant. If severe restlessness or agitation appears unexpectedly after starting, stopping or changing the dose of a medication, akathisia should be considered as a possible explanation.
The two can also occur together, and symptoms should be assessed by an appropriately qualified healthcare professional.
Akathisia or anxiety?
What does akathisia feel like?
People experience akathisia differently.
Possible symptoms include:
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Intense inner restlessness
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An overwhelming need to keep moving
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Pacing
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Rocking or swaying
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Shuffling or repeatedly moving the feet
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Constantly changing position
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Inability to sit or lie still
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Severe agitation
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Insomnia
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Panic
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Extreme anxiety
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A feeling of being trapped inside your own body
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An overwhelming sense of distress or terror
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Intrusive or uncharacteristic thoughts of death or self-harm
Some sufferers describe the experience as almost impossible to put into words.
Importantly, akathisia does not always look dramatic from the outside. A person can be experiencing profound internal restlessness and distress without constantly pacing.
Akathisia is most commonly associated with medication.
It is particularly well recognised as an adverse effect of antipsychotic medication, but antidepressants and some other drugs have also been associated with it.
Akathisia can potentially occur after:
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Starting a medication
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Increasing the dose
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Changing medication
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Reducing the dose
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Stopping medication
The timing of new symptoms in relation to medication changes can therefore provide important information.
What causes akathisia?
What is akathisia?
The word akathisia comes from Greek and refers to an inability to sit.
Clinically, however, akathisia is much more than simply being restless or fidgety. It typically involves a powerful subjective feeling of inner restlessness, sometimes accompanied by an almost irresistible need to move.
Someone experiencing akathisia may pace continuously, rock backwards and forwards, shift their weight from foot to foot, repeatedly cross and uncross their legs, or find it almost impossible to remain seated.
For some people the internal experience is even more distressing than the visible movement.
The UK's Medicines and Healthcare products Regulatory Agency (MHRA) recognises akathisia as an adverse effect of SSRIs, describing it as a feeling of restlessness and an inability to sit or stand still.
Akathisia and suicide
Severe akathisia can involve extraordinary physical and psychological distress.
Suicidal thoughts and behaviour have been reported in association with akathisia, although research examining the relationship is limited and it is not possible to establish that akathisia causes every suicidal act occurring alongside it.
Nevertheless, sudden suicidal thoughts or dramatic behavioural changes following the introduction or alteration of psychiatric medication require urgent attention.
The MHRA states that severe agitation, psychotic symptoms and suicidal ideation are serious symptoms that must be recognised and addressed in people taking SSRIs.
At Antidepressant Risks, we believe patients and families should be told about these potential warning signs so that an adverse reaction can be recognised as early as possible.
Akathisia during antidepressant withdrawal
Akathisia does not only occur when medication is started. It can also occur during withdrawal.
The Royal College of Psychiatrists includes inner restlessness and inability to stay still (akathisia) among the possible symptoms experienced when stopping antidepressants.
Withdrawal symptoms can sometimes be mistaken for the return of someone's original condition.
If new and unfamiliar symptoms appear following a reduction or discontinuation of an antidepressant, the timing and nature of those symptoms should therefore be considered carefully.
Antidepressants should not normally be stopped abruptly. Anyone considering changing their medication should discuss this with an appropriately qualified healthcare professional.
Could this be akathisia?
Think about what changed
Did the symptoms begin after you:
✓ Started a new medication?
✓ Increased the dose?
✓ Reduced the dose?
✓ Switched medication?
✓ Stopped medication?
And what are you experiencing?
✓ An overwhelming need to move?
✓ Pacing, rocking or constantly shifting position?
✓ Severe inner restlessness?
✓ Sudden, extreme agitation?
✓ Inability to sleep or remain still?
✓ Uncharacteristic panic or terror?
✓ New or sudden thoughts of harming yourself?
These symptoms do not prove that someone has akathisia, but they are important information to give to a healthcare professional.
Real people, real experiences
Behind the medical term akathisia are people whose lives have been profoundly affected.
Members of the Antidepressant Risks community have described developing severe restlessness, suicidal thoughts and other symptoms after taking or withdrawing from antidepressants.
Susan's story
Susan developed suicidal thoughts and akathisia after being prescribed an SSRI for sleep. Read Susan's story.
Sean's story
Sean developed akathisia and became acutely suicidal while coming off escitalopram. Read Sean's story.
Stuart's story
Stuart developed akathisia and experienced severe withdrawal effects while trying to come off duloxetine. Read Stuart's story.
Explore more Stolen Lives stories.
Research and resources
If you would like to explore the evidence in more detail, the following are useful starting points.
UK medicines regulator
The Medicines and Healthcare products Regulatory Agency recognises akathisia as a possible psychiatric adverse effect of SSRIs. Read the MHRA guidance.
Royal College of Psychiatrists
The Royal College of Psychiatrists lists akathisia among possible antidepressant withdrawal symptoms in its guidance on stopping antidepressants. Read the Royal College guidance.
Research
Research literature has examined medication-induced akathisia, antidepressant-related agitation and the possible relationship between akathisia and suicidal behaviour. Explore the research.
Lived-experience and awareness organisations
Further information about akathisia and medication-induced harm is available from specialist patient and awareness organisations. Useful organisations and resources.
Frequently asked questions
What is akathisia?
Akathisia is a condition characterised by intense inner restlessness, often accompanied by a powerful need to move. It is most commonly associated with medication and is a recognised adverse effect of some psychiatric drugs.
What does akathisia feel like?
People may experience relentless internal restlessness, agitation and an inability to become physically comfortable. Some pace, rock or continually move their legs. Severe cases can involve extreme psychological distress.
Can antidepressants cause akathisia?
Yes. Akathisia is a recognised potential adverse effect of antidepressants, including SSRIs.
Can sertraline cause akathisia?
Akathisia and severe restlessness have been reported with sertraline and other SSRIs. New or severe symptoms following the introduction of sertraline should be discussed with a healthcare professional.
Can antidepressant withdrawal cause akathisia?
Yes. The Royal College of Psychiatrists lists akathisia among possible antidepressant withdrawal symptoms.
How quickly can akathisia start?
The timing varies. Medication-induced akathisia can occur after treatment begins or following a change in dose. This is why the relationship between medication changes and the onset of symptoms is important.
Is akathisia the same as anxiety?
No. They can feel similar and can occur together, but akathisia characteristically involves profound inner restlessness and often a compulsion to move.
Can akathisia cause suicidal thoughts?
Suicidal thoughts and behaviour have been reported alongside severe akathisia. The precise relationship remains the subject of research. New suicidal thoughts, particularly following a medication change, should always be taken seriously.
Does akathisia go away?
Experiences vary considerably depending on the cause and individual circumstances. Anyone who suspects medication-induced akathisia should seek appropriate medical advice rather than changing medication abruptly without guidance.
If you think you may have akathisia
If severe restlessness, agitation or other unfamiliar symptoms appear after starting, stopping or changing medication, seek medical advice and tell the healthcare professional exactly when the symptoms began and how they relate to any medication changes.
If you are experiencing suicidal thoughts, feel unable to keep yourself safe or are experiencing a medical emergency, seek urgent medical help.
Do not stop psychiatric medication suddenly without appropriate medical advice.