Finding the right treatment plan to combat major depressive disorder (MDD) is a complicated and delicate endeavor. While some antidepressants may work to help alleviate the daily burdens of Depression, the wrong medication can cause more harm than good due to upsetting side effects. One such complex condition is known as akathisia, a side effect that can radically undermine an individual’s overall quality of life.
Understanding and Living with Akathisia
What is Akathisia?
According to the National Library of Medicine, akathisia is a neuropsychiatric syndrome defined by feelings of restlessness and an urgent need to move one’s body. Subjective symptoms include inner tension, anxiety, panic, irritability, discomfort, and sleeplessness, while physical symptoms may consist of irresistible leg movements, difficulty sitting and standing, rubbing or rocking while sitting, and other repetitive movements, with a pathology similar to restless leg syndrome. Physical symptoms may also manifest as vocalizations such as grunting or moaning. In severe cases—and if left untreated—akathisia can lead to dramatic increases in suicidal ideation, aggression, and/or violence.
The Link Between Akathisia and Antidepressants
The first reported case of drug-related akathisia wasn’t diagnosed until 1960 due to the confusing and vague clinical presentation of the disorder. Though the underlying mechanisms of akathisia have yet to be fully understood, there is a definitive link between certain medications and the onset of the condition. Drug-induced akathisia is most often associated with antipsychotics. However, antidepressants, especially when used at high doses and including the most commonly used classes, selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), can also cause akathisia. The pathophysiology behind akathisia in SNRIs/SSRIs is through its serotonergic effects on the nigrostriatal pathway in the brain which leads to a dysregulation of the neurotransmitter dopamine.
Research shows that akathisia seems to be worse in patients with pre-existing renal disease, diabetes, hyperthyroidism, iron anemia, Parkinson’s Disease, and peripheral neuropathy. Akathisia usually presents in days to weeks of starting pharmacotherapy or after increasing a patient’s current dosage, allowing physicians to better identify this condition given accurate temporal information.
Treating Akathisia
The severity of each individual’s akathisia can vary widely given their relative biological and psychological circumstances and the time of onset may be acute, subacute, or chronic. It is commonly assessed and diagnosed through the 4-item Barnes Akathisia Rating Scale (BARS).
Treating akathisia may include reducing the dose of the causal agent or switching treatment for a strategy (such as TMS or Spravato) that does not cause akathisia. If these things are not clinically tenable, adding a medication to the original one to treat akathisia may be helpful. Beta-blockers (such as propranolol) and benzodiazepines (such as clonazepam or lorazepam) have historically been used for the treatment of akathisia although the amount of high-quality data supporting their use is limited. Anticholinergics, amantadine, clonidine and low-dose mirtazapine have also been used with varying efficacy and with minimal evidence.
Finding the Best MDD Treatment Option: Mid City TMS
Living with akathisia caused by your antidepressants can be an incredibly disheartening experience on top of the challenges already associated with MDD. Luckily, there are alternatives, including transcranial magnetic stimulation (TMS) and esketamine therapy (Spravato), that offer lasting relief from Depression without the risk of developing akathisia.
The professionals at Mid City TMS are exceptionally skilled at determining what solutions will prove the most effective and the least disruptive. With the help of our clinicians, you can collaboratively design personalized treatment plans, including using effective strategies such as TMS and Spravato to thereby enhance the possibility of reducing dosages of or discontinuing antidepressant medications that may be causing debilitating side effects such as akathisia.
Contact us today to learn more about our diverse treatment options and discover which of them is truly right for you.