Posted by ed_uk2010 on November 28, 2013, at 12:54:28
In reply to Re: Akathisia question. » ed_uk2010, posted by sigismund on November 27, 2013, at 0:56:53
>I knew what was happening and took straight off the bat something like 100mg Valium which proved to be helpful but not enough, so I took cogentin as well and that was OK.
Evening Sigi,
Well that's it. Akathisia is so difficult to get rid of, the best thing you can do is reduce or (if possible) discontinue the offending drug. In the mean time, benzos and anticholinergics may help some.
Propranolol has been suggested for those who need to stay on the antipsychotic but it seems far better to me to reduce the dose or change the med to something less akathisia-inducing eg. in schizophrenia, crossing over from risperidone to quetiapine. Clozapine, the 'king' of the antipsychotics can cause tonnes of side effects but at least it rarely causes akathisia.
Naturally, the distress of akathisia can aggravate psychosis. A dose reduction may therefore improve psychosis - but will anyone think of this? Someone crawling the walls on haloperidol 15mg/day might be a lot better on 5mg. Akathisia has many faces and can be mistaken for psychotic agitation (which of course can accompany it). But since the pt is 'agitated', they risk getting even more APs and becoming even more agitated. Horrifying thought, especially when the pts in question are often in little position to express themselves easily. Everyone is so focused on their 'underlying condition' that other causes of agitation can easily be missed (and mishandled).
Make sure your doctor's computer records are up-to-date with your drug intolerances. A message will pop up if they try to prescribe.
Some antipsychotics are primarily used to relieve nausea/vomiting so it's important that your prescribers are aware if you cannot tolerate them. Prochlorperazine (Stemetil, Compazine) is one of the most widely used antipsychotic/antinauseants. Other examples are haloperidol and droperidol. Metoclopramide (Reglan, Maxolon) can also cause akathisia and dystonia. You may be able to tolerate low doses well. Personally, I would rather take something else than risk it. There are various options.
In the treatment of depressive or anxiety disorders, I cannot envisage any situation where adding additional long-term meds to counter akathisia would be acceptable. The solution should be to reduce the AP dose, switch drugs, or if the akathisia is mild (with Abilify only) wait to see whether it passes. Of course, additional meds can be used briefly to relieve akathisia in any of the above situations but it should not be for more than a couple of weeks. The fact that akathisia is occurring at all points to something being wrong with the med regimen. It's a bit like when you've accidently added too much spice to a curry; adding more of something else to try and mask it rarely makes it better. You may have to start over! At least with APs you can just reduce the dose, and so starting over isn't always needed.
On another note, I'm not sure how I feel about the increasing tendency of using the term akathisia to refer to nasty restless feelings created by non-antipsychotic psych meds, esp. SSRIs and suchlike. My impression is that AP-induced akathisia is on a level of its own, and may not be the same condition at all, at least not in most cases.
:)
poster:ed_uk2010
thread:1054308
URL: http://www.dr-bob.org/babble/20131115/msgs/1055016.html