last updated 3/26/24
Here is a description of akathisia from an online post:
- itch deep in my bones. Aching itch. Can only be slightly alleviated by constant movement. Pacing non-stop, shaking my hands (like jazz hands) the whole time. Even rocking as I paced. I did 28,000 steps around my house yesterday.
Compare this version:
- I sometimes felt violently suicidal. It is like feeling electricity under my skin that sometimes resolves with movement but sometimes didn’t and I had it for a week and a half.
The first one is so physical, that’s almost surely akathisia. The writer was on a medication known to cause it (aripiprazole/Abilify). But the second version could be interpreted as a depressed mixed state, the most common symptoms of which include “agitation”.
Agitation in mixed states is often defined as “psychomotor restlessness”. That sounds exactly like akathisia, right? That’s my point: akathisia and mixed states are easily confused. And here’s the problem: antidepressants are known to occasionally cause akathisia. But antidepressants are also known to cause mixed states.
Making decisions when you can’t tell
Most important: recognize that akathisia and mixed states can look almost identical. Yes, walking 28,000 steps, that’s akathisia. But if the experience of “too much energy” is more internal than external, more feeling agitated and not so much “I have to move, I have to walk”, that sounds more like a mixed state.
If an antidepressant was recently started, and the over-energized symptoms are bad, then it doesn’t matter whether you call this akathisia or a mixed state. The solution is the same: stop the medication (but if it’s been in use for more than a week or so, you may have to taper it; talk to your prescriber, and read about antidepressant tapering).
If the antidepressant has helped mood enough to want to continue the medication, then you may want to learn more about mixed states. There are numerous treatment options.