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Akathisia vs restlessness, anxiety, agitation


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Please post here for information and questions regarding akathisia.



Any advice I offer is not that of a medical professional. My intro

1. Sertraline: 50mg Oct 2020; 100mg Dec 2020; 50mg April 2021; 75mg May 2021; 50mg 18 Sep 2021; big crash 6-10 Dec 2021; another big crash 22 Sep - 10 Oct 2022; holding and recovering

Current dose: 50mg (April 2023)

2. Mirtazapine: 15mg November 2020;

Current dose: 15mg (April 2023)



1. Amitriptyline: 20mg Dec 2016 for epigastric pain; 10mg Dec 2017; 0mg Oct 2018 - no withdrawal symp.


SUPPLEMENTS: Mag glycinate, Cod liver oil, Vit C;

LIFESTYLE: No alcohol or caffeine

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@MostlyAlivemoved your post to a pre-existing topic.  Thanks Erimus.  You'll find it above and I'll quote, as from my PC we're into a new page now of this topic.


16 hours ago, MostlyAlive said:

We all get sick, fight cancer, broken bones, lose money, careers, loved ones... but people who experience akathisia (including myself) say "it's impossible to describe"

and then - almost invariably - use the word, "torture" proceeded by a "really" or "truly," as if to indicate they wish to be taken literally.


Why is this? 



Edited by manymoretodays
added quote

2022 May- continuing with limited activity on site, just something I need to do right now, and.... 2023 April- I will try again soon for another good break.


Started with psycho meds/psychiatric care circa 1988.  In retrospect, and on contemplation, situational overwhelm.

Rounding up to 30 years of medications(30 medication trials, poly-pharmacy maximum was 3 at one time).

5/28/2015-off Adderal salts 2.5mg. (I had been on that since hospital 10/2014)

12/2015---just holding, holding, holding, with trileptal/oxcarb at 75 mg. 1/2 tab at hs.  My last psycho med ever!  Tapered @ 10% every 4 weeks, sometimes 2 weeks to

2016 Dec 16 medication free!!

Longer signature post here, with current supplements.

Herb and alcohol free since 5/15/2016.  And.....I quit smoking 11/2021. Lapsed.  Redo of quit smoking 9/28/2022.  Can you say Hallelujah?(took me long enough)💜

None of my posts are intended as medical advice.  Please discuss any decisions about your medical care with a knowledgeable medical provider.  My success story:  Blue skies ahead, clear sailing


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On 1/26/2023 at 12:12 AM, MostlyAlive said:

We all get sick, fight cancer, broken bones, lose money, careers, loved ones... but people who experience akathisia (including myself) say "it's impossible to describe"

and then - almost invariably - use the word, "torture" proceeded by a "really" or "truly," as if to indicate they wish to be taken literally.


Why is this? 



I think maybe because most people experience akathisia-like symptoms sometimes, so it's important to qualify one's suffering as something that is above and beyond the minor annoyance of knee bouncing after a cup of coffee or before a big interview.


My own experience in this regard is very mild and not something I would consider to be torturous, however, I have seen footage of patients who suffer with this tremendously, who pace around for hours on end and are practically incapable of any rest no matter how hard they try. Many people might not understand how severe it can actually be, and how profoundly that can affect one's mental health. It's incredibly distressing to essentially have no control over one of the few things we expect to have control over - our bodies. 

It's sort of like really bad migraines. Everybody has headaches, so if you say "I have a terrible headache" people might not fully grasp what you're dealing with. If they haven't experienced a migraine themselves, it understandably may not seem like such a big deal to them. "People don't realize how terrible migraines really are" is an extremely common topic among those who suffer from them.

It's valid to wish to be understood, and to wish that your suffering is taken seriously. "Torture" is an apt description for a condition that prohibits you from rest and deprives you of bodily autonomy.

2014-2015 Clonazepam (Klonopin) 2mg BID, Sertraline (Zoloft) 150mg (Discontinued Clonazepam cold turkey)

2014-August 2021 Sertraline (Zoloft) 150mg (Discontinued cold turkey in hospital, replaced with new regimen)

August 2021 Sodium Valproate 500mg (Depakote), Quetiapine 150mg (Seroquel)

May 2022 Sodium Valproate 500mg (Depakote), Quetiapine 150mg (Seroquel), Hydroxyzine 25mg PRN, Mirtazapine 15mg

July 2022 Sodium Valproate (Depakote) 500mg, Quetiapine 200mg (Seroquel), Hydroxyzine 25mg PRN, Venlafaxine 75mg (roughly 10 days)

August 1 2022 Sodium Valproate 500mg (Depakote)Quetiapine 100mg (Seroquel), Hydroxyzine 25mg PRN, Buspirone 10mg (5-7 days)

August 14 2022 Sodium Valproate 250mg (Depakote), Quetiapine 100mg (Seroquel), Hydroxyzine 25mg PRN

September 7 2022 Sodium Valproate 250mg (Depakote), Quetiapine 50mg (Seroquel), Hydroxyzine 25mg PRN

September 22 2022 Sodium Valproate 250mg (Depakote), Quetiapine 25mg (Seroquel), Hydroxyzine 25mg PRN

October 9 2022 Sodium Valproate 250mg (Depakote), Quetiapine 12.5mg (Seroquel)

October 26 2022 Sodium Valproate 250mg (Depakote), Quetiapine 0.0mg (Seroquel) - #1 Goal Achieved

November 18 2022 Sodium Valproate 0.0mg (Depakote) Drug Free!

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Beautiful answer...

A valid wish to be understood, - to preempt someone from underestimating the situation. (a migraine is not a bad headache)

   Even "torture" is so common that we need to qualify it... "no!, I mean real torture!" to add the required gravitas.


But it's not "real agony" or "real devastation..." but torture. Why "torture." Why do we specifically use "torture" to describe the qualities of the experience.

Reason I ask is -  it's the only word I ever used for it. Before I knew it's name, or that others had it, or that they ALL described it using the same word... torture. AND I couldn't watch a torture scene in a "show" without a flashback for about 5 years. 


deprivation of bodily autonomy?

- is common in many diseases and conditions, but do sufferers describe their condition as (specifically)  "torture?" Prolly not: minus five :D

- is fundamental to torture. YES so: plus 5 :wub:


 prohibits you from rest

-  yup, I think hammer hitting nail. plus 100:)


Remember that Abu guy, wired up,  standing balanced on the cardboard box above the 'water' soaked floor?

(Since that's called a "Stress position," then of course it makes sense to call waiting in line at the ice cream parlor.... torture.)


no rest

AND terror,

AND it's your own fault if (when) you fall down onto the watery prison floor.



Yeah Joey... I think no rest is a good answer.



20+ years on ADs & benzos
2016 - finished 2 year benzo taper from 6mg Xanax to done

     Jan   Started Effexor taper @ 300mg.  A mistake.  May - 37mg to 18mg too big of a drop -> Akathisia , June 6 re-instating 75mg Effexor with Prozac more Akathisia

    June 24 holding 65mg Effexor + 2.5 mg Olanzapine - stabilized Aug  - discontinued olanzapine without issue

2017 - finished Effexor taper  2018 - drug free

2020 - few doses of SSRI -> Akathisia  Lamictal 200mg  
             Have added Lithium 900. Yes... I want to try everything.:rolleyes:

2023 - Lamictal tapered to 150mg. Holding.

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  • 2 months later...
On 3/22/2011 at 6:54 PM, Altostrata said:

This is what a knowledgeable doctor told me:


Agitation is relieved by moving around, but akathisia and restless leg syndrome (RLS) are not. All of them are related to dopaminergic dysregulation; it is unclear whether it's too much dopamine or too little dopamine, this could vary from person to person, or even in the same person, producing the same symptoms. Dopaminergic dysregulation is the key.


The doctor said he wouldn't try to treat dopaminergic dysregulation with drugs. From what he's seen, it resolves in time.


On 3/13/2011 at 9:26 PM, Altostrata said:



Weighted blankets & Bed Tents for restlessness, akathisia, insomnia and anxiety


Blog: My Akathisia Experience by akathisiainfo contains many reports of drug-induced akathisia and recovery from it


Addition September 15, 2022:


Due to the tireless work of patient advocates over the last several years, akathisia has become a better known adverse effect of drugs. However, I have seen more drug-induced activation than akathisia. Quite frequently, members report here they have "akathisia" when they're taking too many "brakes" (sedating drugs such as benzodiazepines, antipsychotics, sleep drugs, etc.). This is not what I would call akathisia but activation from the paradoxical effect of sedating drugs at doses that are too high. 


If you take too many "brakes", your nervous system rebels against being so pressed down, responding with symptoms of activation that might be taken for akathisia. That is a paradoxical reaction, because the drugs are supposed to be calming rather than activating. You have control over a paradoxical reaction, because you can eliminate it by reducing the drug.


You do not have control over akathisia, which is related to a movement disorder, and may persist or emerge after you reduce the drug.


- Altostrata


There's an interesting discussion of akathisia buried in this May 25, 2011 post by psychiatrist Steve Balt http://carlatpsychiatry.blogspot.com/2011/05/horizant-second-coming-of-gabapentin.html


".... However, the symptoms of RLS (restless leg syndrome) are rather nonspecific: "an urge to move the limbs, which improves with activity and worsens with rest." That's about it. Which leads to yet another problem (a problem that GSK and Xenoport don't see as a problem, that's for sure): with such vague and common symptoms (who among us hasn't felt somewhat restless at times, with interrupted sleep?), a lot of people might get diagnosed with RLS when their symptoms are actually due to something else.


A while back, a fellow blogger directed me to the RLS "patient page" on the National Institutes of Health (NIH) web site, where RLS was—and still is—referred to as "akathisia." However, these may be two entirely different things. Akathisia (from the Greek for "not sitting still") has long been recognized as a side effect of some—perhaps most—psychiatric medications, from antipsychotics to antidepressants. It is often described as an "inner restlessness," a "need to keep moving." Sometimes it's associated with extreme emotional distress. In terms of severity, it can range from a mild nuisance to—in some cases—aggressive tendencies. (Indeed, the psychiatrist David Healy has even linked psychotropic-induced akathisia to suicide attempts and violent behavior.)


Psychiatrists really don't know exactly what causes akathisia, and disagree on how to treat it. It may have something to do with dopamine blockade, or something completely independent. Treatment might consist of benzodiazepines (like Ativan or Valium), beta blockers (like propranolol), or discontinuing the drug that caused it in the first place.


Unlike RLS, which seems to bother people most when they are lying down (hence its tendency to disrupt sleep), drug-induced akathisia is worse when people are awake and moving around. Sounds like a simple distinction. But nothing is quite this simple, particularly when psychiatric drugs—and real people—are involved. In fact, many psychiatric meds can cause other motor side effects, too, involving (theoretically) yet other neural pathways, such as "parkinsonian" side effects like rigidity and tremor. In fact, some antipsychotic drug trials show "restlessness" and "akathisia" as entirely separate side effects (and when I've tried to ask experts to explain the difference, I have never received a straightforward answer.) ...."

I'm late to this party, but these are helpful! I've had terrible akathisia some nights and mornings lately, but other times, it's more mild, and I guess it's actually not akathisia but more restlessness and agitation. Like a few minutes ago, I got extremely panicked and felt like my muscles were twitching/itching, but not to the point of wanting to burst out of skin like I'm on fire with no room to stop, drop and roll (that's my description of akathisia, anyway--pardon the dramatics but it sure feels like that sometimes😖). 


So my approach could/should be different...I haven't read through this thread yet but am searching for akathisia/restlessness tips (although I know there's not really a "cure..."). Thank you all

1990s Zoloft, Prozac, and a litany of other drugs including mood stabilizers

1998 Effexor 140mg and Remeron 40mg (I think) - quit cold turkey 2006 and NO W/D! Oh, to be young again... 

2004 Lorazepam 0.5mg; switched to Klonipin 2010

2010 Klonipin 1-2mg/day - decreased gradually down to 0.35mg 2016-2017 & held, then tapered off April-July 2020

2012 Lexapro and Seraquil/Remeron - quit CT 2012 after 1 month of use

2013 Methadone 80mg (for heroin addiction;) decreased to 30mg 2016-2021

2014 Effexor 75mg - tapered off over 1.5 weeks by doc 2017

2017 Citalopram 20mg - started tapering Dec. 2019-March 2020; got down to 14.35 mg then paused to taper off Klonipin

2021 - Citalopram down to 12.8mg in April; July 11.52mg, August 10mg, Oct 9mg, Nov 8.1mg, Dec 7.8mg

2022 - Citalopram 7.4mg

Supplements: L-Tryptophan, 5-HTP, L-Tyrosine, vitamin D, magnesium, ashwagandha, phenibut, lion's mane mushroom, occasional CBD/GABA/kratom, assorted flower essences

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