Akathisia is a frequent and common adverse effect of treatment with
antipsychotic (
neuroleptic) drugs. This syndrome consists of subjective (feeling of inner
restlessness and the urge to move) as well as objective components (rocking while standing or sitting, lifting feet as if marching on the spot and crossing and uncrossing the legs while sitting).
Antipsychotic-induced
akathisia can be classified according to the time of onset in the course of
antipsychotic treatment (acute, tardive, withdrawal and chronic
akathisia). Reported prevalence rates vary widely between 5 and 36.8%. Numerous risk factors for acute
akathisia have been described and the exact pathophysiology of
akathisia is still unknown. Since
akathisia is a
drug-induced adverse effect, optimal management involves its prevention rather than treatment. Standardised titration and the use of novel
antipsychotics are successful measures of prevention. This paper reviews different forms of therapeutic approaches for the treatment of
akathisia. Based on the available literature,
propranolol or other lipophilic beta-blockers seem to be the most consistently effective treatment for acute
akathisia. There is nothing in the literature to guide a clinician when treatment with beta-blockers fails. Addition of
benzodiazepines would appear to be a sensible next choice, especially if subjective distress persists. If all of these drugs are unsuccessful,
amantadine or
clonidine can be tried. Other agents that have been investigated include
ritanserin,
piracetam,
valproic acid (
sodium valproate) and
tricyclic antidepressants. Evidence on the treatment of
tardive akathisia is unsatisfactory.