Akathisia is an inability to remain physically still. It’s a movement disorder that’s linked to certain types of medications, especially antipsychotic medications. People with akathisia feel an intense and uncontrollable need to move — mainly, their lower body.
Akathisia is a neuropsychiatric syndrome and movement disorder that makes it difficult to sit or remain still due to an inner restlessness. The name comes from the Greek word “akathemi,” which means “inability to sit.”
Akathisia is associated with the use of certain types of medications, especially antipsychotic (neuroleptic) medications. A few health conditions have also been linked to akathisia, including Parkinson’s disease.
A person with akathisia experiences an intense sensation of unease or an inner restlessness. This results in a compulsion to move — usually in their lower limbs. In most cases, the movement is repetitive. This uncontrollable need to move can cause extreme distress.
Healthcare providers classify akathisia in a few ways based on its time of onset and duration, including:
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Akathisia and anxiety are different conditions. Akathisia is a movement disorder and anxiety is a type of mental health condition.
While the conditions can have some overlapping symptoms, such as a feeling of restlessness and feeling like you can’t control your thoughts and behaviors, akathisia is mainly a compulsion to constantly move. It doesn’t have fear- or worry-based symptoms. However, this uncontrollable need to move often causes anxiety and distress in people with the condition.
Unfortunately, akathisia is often misdiagnosed as persistent anxiety and/or agitation.
Akathisia is the most common movement disorder associated with psychotropic medication, particularly antipsychotic (neuroleptic) medications. Approximately 24% of people who have schizophrenia and are taking medication for it have chronic akathisia.
In one study, akathisia rates were 39% in people taking clozapine and 45% among people taking first-generation antipsychotics (FGA).
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Akathisia symptoms are most likely to appear soon after you’ve started antipsychotic (neuroleptic) medications or after your dosage has been increased by your healthcare provider.
The main symptom of akathisia is a feeling of internal restlessness or jitteriness. People with akathisia feel a strong compulsion or need to move — mainly, their lower extremities from their hips to their ankles.
If you have akathisia, you may:
To other people, these signs and movements may appear as a persistent fidget.
If you’re experiencing these signs and symptoms, it’s important to talk to your healthcare provider as soon as possible.
People with akathisia typically describe a feeling of restlessness with a strong, uncontrollable need to move. They describe nervousness and an inability to relax.
They may also have a mounting sense of tension when they need to stand still, such as when waiting in line.
Inner restlessness often causes extreme anxiety and distress in people with akathisia. Chronic cases of akathisia have been associated with a high risk of self-harm or suicidal behavior.
If you’re having suicidal thoughts or thoughts of harming yourself, it’s important to seek immediate medical care.
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Scientists don’t know the exact cause of akathisia, but they think it’s due to certain medications blocking dopamine receptors in your brain. Dopamine is a neurotransmitter that plays a role in many important body functions, including movement. The blocking ultimately results in unwanted involuntary movements.
Several medications are associated with akathisia, including:
Certain health conditions are also associated with akathisia, including:
Akathisia is the most common movement disorder associated with antipsychotic medications. Healthcare providers sometimes refer to this as antipsychotic-induced akathisia.
Antipsychotic medications, also known as neuroleptics, fall into two classes:
Akathisia is more commonly linked to the use of FGA medications, especially high-potency drugs and high-dose drugs, than SGA medications.
Healthcare providers prescribe first- and second-generation antipsychotics for various neuropsychiatric conditions, including:
Some examples of FGA medications (and their brand names) that have been linked to akathisia include:
Some SGA medications that are associated with a higher risk of akathisia include:
Less commonly than antipsychotic medications, certain types of antidepressant medications have been linked to akathisia, including:
Healthcare providers prescribe antidepressants to help manage several conditions, including:
Approximately 10% to 18% of people who have bipolar I disorder and take antidepressants are estimated to develop akathisia.
Other medications that have been linked to akathisia include:
Illicit drugs, including amphetamine, methamphetamine and cocaine, can also cause akathisia.
Healthcare providers typically rely on clinical observation to diagnose akathisia. There aren’t any laboratory or imaging tests involved in the diagnosis of akathisia. The most commonly used tool for assessing akathisia is the Barnes Akathisia-Rating Scale (BARS).
If you think you have akathisia, your provider will ask you questions about your symptoms, medical history and current medications to make a diagnosis. They’ll also observe your behavior and movements.
Unfortunately, akathisia is often underdiagnosed because its symptoms often mimic or overlap other psychiatric conditions, including:
There’s currently no definitive treatment for akathisia.
Your provider may manage medication-induced akathisia by switching you to a different medication or by lowering the dose of your medication, if possible.
Some studies have shown that the following medications may help treat akathisia:
Scientists are still working to fully understand akathisia and its cause and treatment. They do know that akathisia is more likely if:
Given this knowledge, the best way to try to prevent akathisia is for providers to start people at the lowest dose of these medications possible and increase the dose a little bit at a time if needed.
It’s important to always talk to your provider about the risks, benefits and possible side effects of a medication before starting them.
The prognosis (outlook) of akathisia is generally good if it’s diagnosed early and the drug causing it is stopped (if possible).
If akathisia is left untreated, it generally causes a poor quality of life. Many people with akathisia develop severe anxiety and dysphoria, and it can even lead to suicidal ideations (thoughts).
If you’re experiencing suicidal ideation, it’s important to seek immediate care. Call 911 or the National Suicide Prevention Lifeline at 800.273.8255. Someone will be available to talk with you 24 hours a day, seven days a week.
If you’re experiencing signs of akathisia, it’s important to talk to your healthcare provider. The sooner they can determine the likely cause, the sooner they can adjust your medications and manage the condition.
A note from Cleveland Clinic
Akathisia can be a very distressing side effect of certain medications. If you’re worried about your risk of developing akathisia after starting a medication to treat a mental health or neurological condition, don’t be afraid to ask your healthcare provider questions. If you’re experiencing signs and symptoms of akathisia, let your provider know as soon as possible.
Last reviewed on 08/05/2022.
Learn more about the Health Library and our editorial process.
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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy