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Akathesia

Overlooked at what cost

By Corinne McCaffertyPublished 2 years ago 4 min read
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Akathisia is a common side effect of many prescription drugs. Antipsychotics, antidepressants and antiemetics are particularly common culprits, but antibiotics and certain conditions (such as Parkinson's) can also cause Akathisia. But what is it, and why is it overlooked?

Akathisia is primarily a movement disorder, described as a subjective feeling of agitation and restlessness. People suffering from Akathisia have described it as severely uncomfortable, often making them feel as if they want to "jump out of their own skin". It can also come with psychological symptoms such as feelings of dysphoria, panic and strange or violent thinking and behaviour. Akathisia ranges from acute and mild to chronic and life-changing. People will commonly experience it when they begin taking a new medication or stop taking it. Often once it reaches a severe or chronic level, it can take months for the condition to subside.

Authors Akagi and Kumar (2002) said that Akathisia was overlooked at great cost to patients, often being misdiagnosed as anxiety or as the underlying mental health issue returning or resisting treatment. This is serious because people suffering from severe or chronic Akathisia have been driven to suicide or homicide. It's difficult to diagnose because it's an extremely subjective experience with a lack of well-defined criteria for diagnosis. As well as this, its tendency to mimic other conditions, such as restless leg syndrome, other mood or psychiatric disorders and other drug-withdrawal states make it very hard to distinguish, often from the conditions that the drugs are prescribed to treat in the first place.

A lack of awareness of the condition also prevents early recognition of the disorder and may lead to increased risk-taking when patients make decisions about their medications without consulting their doctors. Most people that take antidepressants, for example, know that you shouldn't stop taking them cold turkey. However, how many are aware that the consequences for doing so could be so severe as to trigger suicidal and homicidal ideation or actions? If more people knew about this, there would be higher compliance with medical advice surrounding medications. This lack of knowledge also means that, when people start to experience Akathisia, they do not always report it to their GP or physician. In one study of cancer patients undergoing chemotherapy, 50% met the diagnostic criteria for Akathisia, yet 75% of these said that they would not flag their discomfort to their doctor.

Akathisia may also explain a number of violent crimes and suicides that have happened where a person was behaving strangely or out of character. Healthcare workers in psychiatric wards and facilities experience a high number of physical assaults, with 42,000 being reported in the UK in 2016-2017. There were also 17,000 assaults on patients by fellow patients during this time. Could Akathisia be at least partially responsible for a number of these assaults? Particularly considering that many support workers on psychiatric wards may lack awareness of the condition, staff turnover is high, and many in-patients will have received changes to their medications upon entering the facility?

Moreover, in a systematic review (2021) of the evidence for the link between antipsychotic drug-induced Akathisia and suicidality, it was found that existing studies were of poor quality with too few participants to establish whether the correlation was significant or not. This highlighted the need for further study into this condition which affects an already vulnerable subject group.

Adverse drug effects and delayed or inaccurate diagnosis are common causes of patient harm that affects millions of people every year (World Health Organisation). On a podcast called "Akathisia Stories", author Bob Fiddaman describes his experience with Akathisia after quitting his antidepressant by tapering off and then stopping cold-turkey, "Within 24 hours, I was pretty much in a fetal position, you know, suffering stomach cramps, head zaps, intrusive thoughts. It was pretty bad. And it took about three months of absolute torture to get through to the other side". The podcast is produced by MISSD, the Medication-Induced Suicide Prevention and Education Foundation in Memory of Stewart Dolin. This nonprofit organisation is dedicated to honouring the memory of Stewart Dolin and other victims of Akathisia by raising awareness and educating the public about its' dangers. They aim to ensure that people suffering from Akathisia are accurately diagnosed so that needless deaths are prevented. The foundation advocates truth in disclosure, honesty in reporting, and legitimate drug trials. You can check out the podcast here: https://www.studiocchicago.com/akathisia-stories

By raising awareness of Akathisia and increasing public understanding, we can reduce the needless suffering of vulnerable individuals. Between 2007 and 2014, the number of people in the UK taking antipsychotic medication increased from 0.5% to 1.2%. Of these, we do not know how many may have suffered the effects of Akathisia, nor do we know how many fully understand the risks involved with changing medications, doses, drug brands or stopping altogether. We must support the people in our lives who are taking medications so that they can make safe decisions, and we must also be mindful of Akathisia whenever we go through a medication change ourselves. By being transparent with our support network when we are going through a medication change and keeping in touch with our doctor we can reduce the risk that we will develop chronic Akathisia.

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Corinne McCafferty

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