Akathisia: Symptoms, causes, diagnosis, and treatments

Reviewed by Asad Ghiasuddin, MD

Written by

therapist.com team

Last updated: 04/29/2025

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What is akathisia?

Akathisia is a movement disorder that makes it hard for a person to stay still.¹ It presents as an overwhelming feeling of inner restlessness or a strong need to move that you can’t control.

The term was first used in 1901 by a Czech doctor to describe an “inability to sit” in some of his patients. It wasn’t until 1960 that doctors started using it to describe a side effect of medications.

Today, akathisia is most commonly classified alongside other medication-induced movement problems like parkinsonism and dystonia. When related to medication use, these side effects are collectively called extrapyramidal signs (EPS).

Akathisia symptoms

Akathisia can mimic symptoms of several other conditions, including anxiety, depression, attention-deficit/hyperactivity disorder (ADHD), Parkinson’s disease, psychosis, and mania.² Clinically, its characteristic trait is an inner sense of discomfort and restlessness.

Visible signs of akathisia

People with akathisia feel an inner restlessness than can result in an intense urge to move their torso and limbs.³ The resulting movements may be repetitive and look like fidgeting.⁴

People with the condition might:

• Cross and uncross their legs repeatedly
• Swing their limbs
• Shift their weight from one foot to the other
• Rock back and forth
• Pace restlessly

Akathisia causes

Akathisia is one of the most common and distressing movement disorders caused by psychiatric medications. In a review of 15 studies involving patients taking antipsychotic medications, the prevalence rate was 11%.⁵

Akathisia is most commonly associated with antipsychotic medications. However, many other drugs can cause it, including:⁶

• Certain antidepressants like selective serotonin reuptake inhibitors (SSRIs)
• Some non-psychiatric medications like antibiotics and calcium channel blockers
• Some illegal drugs like amphetamines, methamphetamine, and cocaine

In some cases, akathisia can occur in people who haven’t taken any medications. One study review showed a prevalence rate of 4% in psychosis patients who had never taken antipsychotics.⁷ It can also appear as a feature of other neurological and medical conditions such as Parkinson’s disease.

Diagnosing akathisia 

Medical professionals are trained to look for signs of akathisia in people taking medications known to cause it. They can take a thorough medical history, rule out similar conditions, and create a treatment plan.

It’s believed that akathisia may be underdiagnosed.⁸ If you have concerns, it’s important that you have an open discussion with your health care provider as soon as possible. They can help you tune in to what your body is telling you and prevent the condition from getting worse.

Types of akathisia

Akathisia can be classified into several types.⁹ The defining difference between each type comes down to the timing of symptoms.

• Acute akathisia appears within a few days or weeks of either starting or increasing the dose of medication.
• Subacute akathisia develops more gradually, emerging after the initial weeks of medication use.
• Chronic akathisia involves symptoms lasting longer than three months.
• Tardive akathisia appears after long-term medication use, typically developing months or years after starting treatment. It may continue even after a person stops taking the medication.
• Withdrawal akathisia occurs within two weeks of medication being stopped or reduced.

Will akathisia go away on its own?

Akathisia usually stops when the triggering medication is stopped or its dose is reduced.¹⁰ You can’t count on the condition going away without this intervention. Once it develops, it may unfortunately take months, or even years, to resolve.¹¹

Suddenly stopping prescribed medication is not recommended. The medications that most commonly cause akathisia are used for serious mental health concerns. When healthcare providers—including mental health nurses, pharmacists, and primary care physicians—recognize the condition, they may need to refer the patient to a psychiatrist for specialized treatment.

If you think you might be experiencing akathisia, it’s important to speak with your health care provider or a mental health professional immediately. Never stop taking prescribed medications without medical supervision, as this can cause serious health problems.

Akathisia treatment options 

Akathisia caused by antipsychotic medications should be treated in a way that’s tailored to each patient. Treatment will depend on factors like severity of symptoms and the medications used. In general, there are two main ways to manage it:¹²

1. Making changes to the antipsychotic medication routine. This might involve:

• Using the lowest effective dose
• Avoiding multiple antipsychotics at once
• Gradually reducing the dose if possible
• Switching to a different antipsychotic

These changes might increase the risk of psychotic symptoms returning, which is why it’s important to work with a mental health professional you trust who has experience treating this condition.

2. Adding other medications that may help reduce akathisia. Some of the most common medications used to treat it include:

• Non-selective beta-blockers, which are considered the first choice and most effective
• Mirtazapine, which is used when beta-blockers can’t be used or don’t work well
• Benzodiazepines, though they’re only recommended for short-term treatment to avoid side effects and dependence

To find out more about akathisia diagnosis and treatment, consult with a psychiatrist who specializes in medication management. Visit our directory to find qualified mental health professionals in your area.