A debilitating condition, often mistaken for psychiatric crises, can arise as a side effect of medications prescribed to millions of Americans, leaving individuals in a state of agonizing restlessness and inner terror. Akathisia, a well-documented but infrequently recognized adverse reaction, compels sufferers to move uncontrollably, making it impossible to sit still, sleep, or perform daily activities.

Katie Brennan, a 48-year-old mother of six from north-central Minnesota, experienced this firsthand after being prescribed several common psychiatric drugs in October 2014. Following a period of stress related to a job change, she mentioned sleep difficulties during an allergy appointment and was given a mental health questionnaire. She left with prescriptions for zolpidem (Ambien) for sleep, fluoxetine (Prozac) for depression, and lorazepam (Ativan) for anxiety.

Initially, the Ambien seemed to worsen her sleep. Soon after starting Prozac, Brennan reported an "overwhelming" feeling of panic and agitation, accompanied by an "almost uncontrollable need to move." She described her nervous system as feeling "on fire" and experienced an intense urge to pace for hours, rock back and forth when trying to sit, and even ride a bicycle up and down a hill repeatedly.

Her family contacted her medical provider, who prescribed sertraline (Zoloft), another antidepressant. Brennan stated this intensified her symptoms, comparing it to "pouring gasoline on a fire." When she was subsequently prescribed Ativan, it offered some calm but did not restore her to normalcy. She continued to struggle with sleep and restlessness, experiencing pain if she stopped moving, likening it to trying to "crawl out of my skin."

By December 2014, her condition had worsened to the point where her family took her to the emergency room. She was admitted for observation but discharged after two days without a diagnosis. The inability to control her movements led to her dismissal from her teaching job in March 2015. Her life continued to unravel, and she underwent a civil commitment, a form of forced hospitalization for individuals deemed mentally ill, for approximately one year.

Diagnosis and Misdiagnosis

In the latter half of 2016, a referral to a new doctor offered a turning point. This physician, Brennan stated, listened to her symptoms and recognized that she had no prior history of such problems. The diagnosis was akathisia.

Akathisia is characterized by intense motor restlessness and an overwhelming urge to move. While it can manifest as pacing, fidgeting, or rocking, it can also involve profound inner torment, anxiety, and agitation that escalates when the individual attempts to remain still. Symptoms can emerge shortly after initiating or increasing medication, or even months later or after discontinuing a drug. Due to its resemblance to psychiatric distress, it can be misdiagnosed as anxiety, mania, or psychosis, potentially leading to increased medication or additional prescriptions.

Psychiatrists note that clinicians sometimes prescribe multiple medications or even electroconvulsive therapy in attempts to manage severe symptoms, which can paradoxically exacerbate the condition. Reliable figures for the prevalence of akathisia in the United States are unavailable, but studies suggest it affects a significant percentage of patients on certain psychiatric medications. It has also been linked to anti-nausea medications like metoclopramide.

For the vast majority of individuals who take these medications, akathisia does not develop. The exact cause for its occurrence in some individuals remains unclear, though it is thought to involve disruptions in dopamine, a brain chemical crucial for movement control.

A Complex Path to Recovery

Treatment for akathisia can be challenging. Reducing medication dosage or switching to a different drug are common strategies if a medication is suspected as the cause. However, abrupt discontinuation of certain psychiatric drugs can trigger severe withdrawal symptoms, including akathisia itself.

Brennan's recovery was not linear. After initial improvement as her medications were reduced, her symptoms resurfaced when she was prescribed clozapine, an antipsychotic for schizophrenia. She reported experiencing hallucinations and, in March 2017, jumped from a 60-foot bridge. She survived with only bruises but was committed to psychiatric care for nearly a year.

Upon her release, she returned to the doctor who had diagnosed akathisia and continued reducing her medication. In 2019, another episode triggered manic behavior, leading to a third civil commitment lasting six months. After discharge, she once again gradually reduced her medications, finally stopping Ativan in the spring of 2021.

Now 59, Brennan reports that her akathisia symptoms have subsided. She emphasizes that her goal in sharing her story is to increase awareness among patients and clinicians about the warning signs of akathisia. She is not advising against the use of necessary psychiatric medications but hopes that by recognizing the symptoms early, others can minimize suffering and avoid the devastating impact the condition had on her life, which she estimates cost her a decade of her life and time with her children.