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Re: Akathisia question.

Posted by psychobot5000 on November 23, 2013, at 18:51:27

In reply to Re: Akathisia question., posted by Angela2 on November 14, 2013, at 22:02:00

> http://en.wikipedia.org/wiki/Akathisia
>
> I've had it in the past as a reaction to medication I was on. It doesn't hurt. But it's like I wanted to keep pacing, felt like I had to keep moving. Fun times!

I have to respond to this, if only to STRONGLY object to the sign-off 'Fun times!' I realize this was meant ironically, but I don't think it's helpful in helping understand the drug-induced symptoms. I've undergone a lot of pain and a lot of depression, and, that said, akathisia--even moderate akathisia that's not yet bad enough to force me to move--is one of the most horrible experiences I've ever endured; what's more, I'm coming around to the view that it's very likely that many SSRI-startup related suicides (that strange bump in mortality over the first few weeks which, to my knowledge has never been adequately explained) is probably due to akathisia. Antidepressants, SSRIs in particular, give you akathisia with reasonable frequency (I had it with most SSRIs given to me--when I looked up side-effects at some point, I hadn't to read much: 'a subjective feeling of inner restlessness' to immediately recognize what I'd experienced before. Even mild akathisia is pretty intolerable, in my experience, even compared to fighting depression. The only thing that textbook quote I just gave left out was the negativity of the experience: it's a true horror to live through. I can't say whether it directly affects your mood, but in a more recent bout of akathisia due presumably to AAP blood levels getting to high because of drug-interactions, I seriously considered dying because I couldn't figure out how to get through a night and morning to the point where I could fill a prescription to partially suppress the symptom.

Takeaway, simply: akathisia is, in my experience, profoundly unpleasant as well as poorly understood, and it's important to learn to distinguish it from standard anxiety (or from anxiety at all if one doesn't consider it a form of physical anxiety; whatever, it's just semantics. All that matters is the reality).

I don't base this entirely on my own experience. I was in a writer's group in which someone submitted a story in which someone is given a recreational dose of an SSRI, which made the character feel absolutely horrible in a way that sounded like, well, akathisia (in the story, the character becomes very angry at the person who gave her the dose of...zoloft, I think it was). It was a workshop, so I questioned the accuracy of this portrayal, and a number of people jumped in to defend it based either on first or second-hand knowledge of the way SSRIs had made them, or someone they'd spoken to, feel, and...it was a little hard to tell, but I pressed a bit and there was a lot of resistance to my questioning of the accuracy of this fictional bit (keep in mind that creative writers and their relatives manifest psychiatric illnesses at a substantially higher rate than the normal population). Clearly, this akathisia-like description of the first feelings an SSRI might give you rang true to a lot of people in this room of twelve or so writers, and while I doubt a single dose of zoloft would give many people a significant portion of akathisia...this, combined with my horrible-beyond-words-to-describe-it 24-48 hour recent bout with akathisia recently leads me to believe that the UNPLEASANTNESS, or, better, HELL of akathisia (see the web-based urban dictionary's second definition), subjectively, should not be ignored. It's a much better explanation for antidepressant-onset-induced suicide than anything else I've ever heard suggested.

Akathisia. Is. Horrible. (at least in my experience and, in among a very significant portion of those talking about it on the web, and among that writers' group). Sorry to belabor this, but I feel it's a very important point; I think it's idiocy to give a potentially depressive person a beta blocker that crosses the BBB, but in the case of akathisia, you may have to (in addition to, say discontinuing the offending medication) just suck it up and take that propanolol for a couple days and hope you have a loved one nearby reminding you for the next few days after that you have things to live for, and it won't always feel like this.

There are several excellent antidepressants which I currently refuse to take because I sadly know they give me acute akathisia. Also: great story! I know of an otherwise intelligent depressive patient with good judgment who very rapidly escalated her dose of klonopin in a desperate (I would say) attempt to suppress the onset of akathisia. Normally, I would trust her judgment immensely, but the evident horror of the side-effect (she felt she needed the causative antidepressant in order to function...a very bad choice IMO) made her pop those pills like candy (she'd typically underdosed the stuff, it seems, so fortunately or unfortunately had a modest stockpile) until I saw with some shock what was going on. I was unable to convince her to change anything (by that point her judgment was probably impaired), but at least was on-hand to convince her FINALLY to stop taking the akathisia-causing agent when she realized something was seriously wrong...and that she was running out of dangerous pills to 'fix' the situation (a few days later she admitted to acting like a crazy person). ...I think she had enough remaining clonazepam to cushion the benzo withdrawal, but the full-blown akathisia--now unconcealed by absurd doses of the minor tranquilizer--seemed horror enough. I didn't entirely understand her experience because, at this point, it had been a while since I'd been through any serious akathisia, but the distress (and her very uncharacteristic and irresponsible use of controlled medication) was evident enough that I considered her a suicide risk for a day or so. She's probably lucky she had the days built up to call in sick for 48 hours, get to the weekend, and have me watching her. Again, I didn't fully understand at the time, but it seemed to me that whatever had her pacing (and I did have enough memory of akathisia from years earlier to 'get it' to some extent) was probably a lot worse than the benzo withdrawal she was also dealing with. Jesus. She was clearly afraid, which freaked me out a little, since she normally is a lot healthier than I am. Rrrh. When something gives you akathisia, STOP, people.

Sorry for the length of this post. But my point is simple. I think I can say pretty broadly that it can be dangerous, even as a casual throwaway comment, to dismiss akathisia as 'Fun times.' I know probably very little was meant by that. Rather, I just hope to help a person or two who might stumble across this thread to make sure they take this drug-induced side-effect very seriously, and do what they can to avoid the experience. To wit: akathisia is (or can be) a true horror, even if it's not precisely pain. Respect and avoid! Take the antidepressant that makes you fat, instead. Whatever you have to do. Oh, and benzodiazepines probably aren't a good 'solution' for the problem, even if they work temporarily.


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Psycho-Babble Medication | Framed

poster:psychobot5000 thread:1054308
URL: http://www.dr-bob.org/babble/20131115/msgs/1054813.html