Overview
Akathisia is a common and distressing side effect of psychotropic medications, particularly antipsychotics, affecting 14% to 35% of patients 12. It is characterized by a subjective sense of inner restlessness and a compelling need to move 2. Akathisia is associated with increased suicide risk and decreased treatment adherence in patients with schizophrenia 1.Diagnosis
Diagnosis is based on clinical presentation, including subjective restlessness and objective motor restlessness 2.
Validated akathisia scores are used in research settings 1.Management
First-line treatments:
* Benzodiazepines, beta-blockers, and mirtazapine, naSSa (mirtazapine + sodium-lithium-sulfate-acetate) have demonstrated significant efficacy compared to placebo 2.
* Benzodiazepines ranked highest in efficacy 2.
Adjunctive treatments:
* Anticholinergic, anticonvulsant, and triptan treatments did not show significant differences compared to placebo 2.
Antipsychotic selection:
* Sertindole and quetiapine carry negligible risks for akathisia across examined doses 3.
* Risperidone and lurasidone have dose-dependent risks of akathisia 3.Key Recommendations
Benzodiazepines, beta-blockers, and mirtazapine (NaSSA) are effective treatments for akathisia 2. (Evidence: Strong)
Sertindole and quetiapine have a low risk of inducing akathisia 3. (Evidence: Strong)
Clinicians should consider the dose-response relationship of antipsychotics, as some agents like risperidone and lurasidone have increasing akathisia risk with higher doses 3. (Evidence: Strong)References
1 Gerolymos C, Barazer R, Yon DK, Loundou A, Boyer L, Fond G. Drug Efficacy in the Treatment of Antipsychotic-Induced Akathisia: A Systematic Review and Network Meta-Analysis. JAMA network open 2024. link
2 Gambolò L, Bottignole D, D'Angelo M, Bellini L, Stirparo G. Comparative efficacy of akathisia treatments: A network meta-analysis. CNS spectrums 2024. link
3 Wu H, Siafis S, Wang D, Burschinski A, Schneider-Thoma J, Priller J et al.. Antipsychotic-induced akathisia in adults with acute schizophrenia: A systematic review and dose-response meta-analysis. European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology 2023. link