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Akathisia: Symptoms, Causes, and What to Do

Akathisia symptoms, the drugs that cause it, why it matters, treatment options, and when to get urgent help.
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  • Medically Reviewed
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Alternative to Meds Editorial Team
Medically Reviewed by Dr John Motl MD

Akathisia at a glance

Akathisia can be severe and frightening. If you have thoughts of suicide or harming someone, call or text 988, or call 911. Don’t stop or change a medication on your own; call your prescriber today.

What it is
A drug-induced state of intense inner restlessness and an urge to keep moving
How it feels
Tense, uneasy, unable to sit still; often pacing, rocking, or shifting from foot to foot
Common causes
Antipsychotics such as aripiprazole, cariprazine, and lurasidone; less often SSRIs and other antidepressants
When it starts
Usually within days to weeks of starting a drug or raising the dose; sometimes after lowering or stopping one
How common
About 14% to 35% of people treated with antipsychotics
Why it matters
Linked to distress, suicidal thoughts, and aggression; often mistaken for anxiety or agitation
First steps
Prescriber review: lowering the dose, switching, or adding a treatment
At ATMC
Residential, medically supervised medication tapering in Sedona, Arizona
SymptomsDrugs that cause itTreatmentGet help now
Table of contents (14)

What is akathisia?

Akathisia is a movement-related side effect of some medications that causes an intense feeling of inner restlessness and a strong urge to move. People with akathisia often can’t sit or stand still, and they may pace, rock, or shift their weight from foot to foot.1,3

It is most often caused by antipsychotic medications, but antidepressants and other drugs can cause it too.1,2,6 It usually starts within the first few weeks of a new medication or a dose increase.1,2

Akathisia is more than feeling fidgety. The core of it is a distressing sense of unease, and in severe cases it has been linked to suicidal thoughts and aggressive behavior.2,3 It is also treatable once it is recognized. If you think you have it, you are not imagining it, and your prescriber should hear about it right away.

Want medical support while you taper? Learn how our residential medication tapering program in Sedona works, or call (888) 907-7075.

Akathisia symptoms: what does akathisia feel like?

Short answer: akathisia feels like an inner restlessness you can’t switch off, often with a mounting tension when you try to keep still. Others may notice pacing, rocking, or constant leg movements.1,3

Akathisia has two parts: what you feel inside and what others can see.2,3

What you may feel:

  • Inner restlessness: a compulsion to move, usually felt most in the legs1
  • Mounting tension when still: for example, while waiting in line or sitting through a meal3
  • Unease and dysphoria: an intensely unpleasant mood, often with anxiety1,3
  • Trouble resting: difficulty sitting through meals, TV, or conversations3

What others may see:

  • Pacing, or marching in place while standing3
  • Rocking, shifting position, or getting up and down1
  • Legs swinging, or crossing and uncrossing while sitting3
  • Shifting weight from one foot to the other3

Clinicians often use the Barnes Akathisia Rating Scale. It rates what is observed, how aware the person is of restlessness, how much distress it causes, and an overall score.2

Why akathisia matters, and when to get urgent help

Short answer: akathisia can be one of the most distressing medication side effects. Research has linked it to suicidal thoughts, aggression, and violence, though research has not shown that it causes them. Treat it as urgent.2,3,17

In a study of 289 people with a first episode of schizophrenia, suicidal thinking was significantly associated with akathisia that clinicians could observe.16 Reviews describe worsening akathisia as linked to new or worse suicidal thoughts, aggression, and violence.2,5 A 2021 systematic review found only a few low-quality studies, so the link can’t be called proven, but its authors still advise checking for akathisia proactively.17

U.S. antidepressant labels also list akathisia (“psychomotor restlessness”) among symptoms to watch for, along with anxiety, agitation, panic attacks, insomnia, irritability, and impulsivity. The labels note that such symptoms may come before new suicidal thinking.12,13

Get help right away:

  • Call or text 988 for the Suicide and Crisis Lifeline if you have thoughts of suicide or self-harm. It is free, confidential, and open 24/7.26
  • Call 911 or go to the nearest emergency room if you or someone else is in immediate danger.
  • Call your prescriber the same day if you notice new restlessness after starting, raising, lowering, or stopping a medication.2,3

For families: akathisia can look like agitation or bad behavior. If a loved one suddenly can’t sit still, seems tormented, or acts out of character after a medication change, ask about akathisia and help them reach their prescriber.

What drugs cause akathisia?

Short answer: antipsychotics are the most common cause. SSRIs and other antidepressants, some anti-nausea drugs, and stimulants can also cause it.1,2,6

Estimates vary by drug and study, but akathisia affects roughly 14% to 35% of people treated with antipsychotics.7 In one community sample on stable antipsychotics, 18.5% had it, with higher rates in people taking two antipsychotics at once.3

Akathisia rates on FDA labels (newer antipsychotics):

Drug and use studied On drug On placebo
Abilify (aripiprazole): Add-on for depression 25% 4%
Abilify (aripiprazole): Bipolar mania 13% 4%
Abilify (aripiprazole): Schizophrenia 8% 4%
Vraylar (cariprazine): Bipolar mania 20% 5%
Vraylar (cariprazine): Schizophrenia 11% 4%
Vraylar (cariprazine): Bipolar depression 8% 2%
Latuda (lurasidone): Schizophrenia 13% 3%
Latuda (lurasidone): Bipolar depression 9% 2%
Rexulti (brexpiprazole): Add-on for depression 9% 2%

Sources: current FDA prescribing information on DailyMed.8,9,10,11 Rates were higher at higher doses for several of these drugs.8,10,11 The Vraylar label advises watching for akathisia for several weeks after starting and after each dose increase.8

Other medications linked to akathisia:

  • Older (first-generation) antipsychotics, which carry some of the highest rates2,5
  • SSRIs such as fluoxetine (Prozac) and sertraline (Zoloft). Akathisia is listed on the Prozac label, and on the Zoloft label among reports after approval.12,14,15
  • Bupropion (Wellbutrin): listed in trials at 2% vs. 1% on placebo13
  • SNRIs and mirtazapine6
  • Anti-nausea drugs that block dopamine1,2
  • Stimulants, including prescription stimulants and illicit amphetamine, methamphetamine, and cocaine2,6

Can Adderall or Vyvanse cause akathisia? Stimulant labels list restlessness but don’t use the word “akathisia.” Reviews report akathisia with stimulants, and there are published case reports.6 If restlessness on a stimulant feels driven and distressing, tell your prescriber.

Not everyone who takes these drugs gets akathisia. Your risk depends on the drug, the dose, how fast it is changed, other medications you take, and your own history.2,3 Read more about Vraylar, Latuda, and Abilify.

Struggling with akathisia from a medication? Talk to our team about medically supervised tapering and what a residential stay looks like.

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Types of akathisia: acute, chronic, tardive, and withdrawal

Short answer: akathisia is grouped by when it starts and how long it lasts. Most cases are acute, starting soon after a new drug or dose increase.2,3

Type When it starts How long it lasts
Acute Within days to weeks of starting a drug or raising the dose Often improves when the dose is lowered or the drug is changed
Chronic Starts like acute akathisia Continues for more than 3 months
Tardive (late) Months into treatment, or even after lowering or stopping a drug Can persist for months to years after the drug is stopped
Withdrawal Within about 2 weeks of stopping an antipsychotic or lowering the dose Usually resolves within 6 weeks; if longer, it may be called tardive

Sources: Salem 2017 and Pringsheim 2018.2,3 Experts note these groups overlap, and the terms are not always used the same way.3,21 The DSM-5 lists medication-induced acute akathisia and tardive akathisia among medication-induced movement disorders.24

Akathisia after stopping or lowering a medication

Short answer: yes, akathisia can appear when an antipsychotic is lowered or stopped. This withdrawal akathisia usually starts within 2 weeks and often settles within 6 weeks, but it can last longer.2,5

Withdrawal akathisia looks and feels the same as acute akathisia.3 It is one reason antipsychotics should be reduced gradually under medical care.

How long does akathisia last after stopping Abilify? There is no Abilify-specific timeline. In general, withdrawal akathisia after an antipsychotic is lowered or stopped often resolves within about 6 weeks. When it lasts longer, it may be tardive akathisia, which can persist much longer.2,5 See our guide to Abilify withdrawal.

Antidepressants and benzodiazepines: withdrawal from these drugs can cause agitation, anxiety, and restlessness. Benzodiazepine labels list restlessness and abnormal involuntary movements among withdrawal signs.23 These are not always true akathisia, but they can feel similar and deserve the same prompt attention. Learn more about benzodiazepine withdrawal.

Akathisia or something else?

Short answer: akathisia is often missed or mistaken for anxiety, agitation, worsening psychosis, or restless legs syndrome. Getting it right matters, because raising the dose of the drug causing it can make it worse.2,3

According to reviews, akathisia often goes unrecognized or is misdiagnosed as:1,2,3

  • Anxiety, agitated depression, or mania
  • Psychotic agitation or a relapse of the original illness
  • Restless legs syndrome
  • ADHD
  • Substance intoxication or withdrawal
  • Tardive dyskinesia, another movement disorder

When akathisia is mistaken for anxiety or agitation and the dose is raised, the result is often worse akathisia and more distress.2 A useful clue is timing: did the restlessness begin after a new drug, a dose increase, a dose decrease, or a switch?1,2

Can you have akathisia without medication? Akathisia is mostly caused by medications. Similar restlessness can come from other conditions, such as anxiety or restless legs syndrome, so a medical check is worthwhile. Akathisia can also continue after a medication has been stopped.2,3

Why do medications cause akathisia?

Short answer: the exact cause is unknown. The leading theory is that blocking dopamine D2 receptors upsets the balance between dopamine and other brain chemicals, including serotonin and norepinephrine.1,2,22

Antipsychotics work largely by blocking dopamine, which also helps control movement.1 That fits the theory, but other findings don’t. Akathisia doesn’t usually respond to the anticholinergic drugs used for other movement side effects, which suggests a different mechanism.1 Serotonin, norepinephrine, and GABA have all been implicated, which may explain why so many types of drugs can cause it.2,22 Reviewers agree there is no single, unifying explanation yet.4,22

How is akathisia treated?

Short answer: treatment starts with your prescriber reviewing the medication. A Canadian guideline recommends lowering the dose, stopping extra antipsychotics, or switching drugs before adding another medicine.3

Step 1: review the medication. This may mean a lower dose, a slower dose change, cutting back to one antipsychotic, or switching to a drug less likely to cause akathisia.3 These decisions need to be made with your prescriber, because stopping suddenly can cause withdrawal and relapse.

Step 2: treatments your prescriber may consider. Doses aren’t listed here on purpose; they must be set by a clinician.

Option What the evidence says
Propranolol (a beta-blocker) The most studied and a first-choice option in the Canadian guideline. Can lower blood pressure and heart rate.3,18
Low-dose mirtazapine In a 90-person trial, 43% improved vs. 30% on propranolol and 7% on placebo, with fewer side effects than propranolol.18
Clonazepam (a benzodiazepine) A short-term option. Benzodiazepines carry their own risk of dependence.3,23
Vitamin B6 Helped in two small, short trials and may be considered when other treatments fail. Long-term high doses can damage nerves.3,19,20
Anticholinergics Should not be used routinely; may help if Parkinson-like symptoms are also present.2,3

A 2024 analysis of treatment trials found mirtazapine, biperiden, and vitamin B6 had the largest effects.7 Mianserin and other drugs that block serotonin 5-HT2A receptors have also been studied.3,20

Can akathisia be treated naturally or without medication?

Short answer: the most effective non-drug step is usually changing the medication that caused it, with your prescriber. Vitamin B6 has some trial evidence, but it should be used under medical guidance, not as a replacement for a medication review.3,19

Many people search for natural akathisia treatment, and that makes sense when a medicine is the cause. Here is what the evidence supports:

  • Fixing the cause first. Lowering the dose or switching drugs, done with your prescriber, often works best.3,6
  • Vitamin B6. In small trials, it reduced akathisia over 5 days.19,20 Check with your prescriber first, since high doses over time can cause nerve damage.3
  • Movement and routine. Walking and gentle activity may make waiting out symptoms more bearable. There isn’t research showing they treat akathisia.

Supplements and lifestyle changes are not a substitute for medical care during akathisia. Akathisia can be dangerous, and it needs a clinician involved.

Does akathisia go away?

Short answer: usually, yes. Acute akathisia commonly resolves once the drug is lowered, stopped, or switched. Chronic and tardive forms can last much longer.1,6

The outlook is good when akathisia is recognized early and the drug causing it is changed.1 Even then, it can take time, sometimes months, for symptoms to settle fully.1 Tardive akathisia can persist for years in some people, even without the medication.2,5

Can akathisia go away on its own? Some cases ease with time, but waiting it out alone isn’t safe advice because of the risk of severe distress and suicidal thoughts. Tell your prescriber so they can adjust treatment. You or your prescriber can also report the side effect to FDA MedWatch.2,3,17,25

The role of a supervised taper

Short answer: if you and your prescriber decide to reduce or stop a medication that caused akathisia, a gradual, monitored taper lowers the risk of withdrawal akathisia and relapse.2,3

Changing doses too fast can trigger withdrawal akathisia, rebound symptoms, or a return of the original condition.2,5 A good taper plan is slow enough to watch for problems and flexible enough to pause or adjust. It also includes a plan for sleep, mood, and safety if symptoms flare.

Each type of medication has its own considerations. Learn more about antipsychotic withdrawal, antidepressant withdrawal, stimulant withdrawal, and coming off benzodiazepines.


Watch: understanding anxiety and medication withdrawal symptoms.

Get help with drug-induced akathisia

Alternative to Meds Center is a residential treatment center in Sedona, Arizona, with nearly 20 years of experience helping people taper psychiatric medications, including antipsychotics and antidepressants. Many people come to us after side effects such as akathisia made their medication hard to live with.

Each resident gets lab testing and a medical assessment on arrival. Our medical team plans each dose step, using half tablets or liquid preparations as needed, and adjusts the pace as you respond. The program also includes neurotransmitter support, orthomolecular medicine, whole-food nutrition, counseling, and dual diagnosis care. These supports work alongside medical care; they don’t replace it.

Our Medical Director describes how the team runs a taper:

“Our medical and nursing teams collaborate closely to monitor each client’s tapering plan, assess progress, and make adjustments as clinically indicated. The team regularly evaluates symptoms, sleep patterns, mood, and overall well-being to support a safe and individualized process.”
Kimberli Galloway, PMHNP-BC, Medical Director

See where you’d stayTour our Sedona residence →Hear from clientsReal recovery stories →

Talk to our admissions team. Ask about a supervised taper, what a stay looks like, and insurance. Family members are welcome to call.

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Akathisia FAQs

What does akathisia mean?
Akathisia means an inability to remain still. It describes a drug-induced inner restlessness with an urge to move, often seen as pacing, rocking, or shifting from foot to foot.1,3
When should I seek medical help for akathisia?
Right away. Call your prescriber the same day if new restlessness starts after a medication change. Call or text 988 for thoughts of suicide, and call 911 if anyone is in immediate danger.2,3,26
Should I stop my medication if I have akathisia?
Don’t stop it abruptly on your own. Stopping suddenly can cause withdrawal akathisia and relapse. Contact your prescriber, who may lower the dose, switch drugs, or add a treatment.2,3
Does Vraylar cause akathisia?
Yes, it is one of its most common side effects. On the FDA label, akathisia affected 20% of people treated for bipolar mania vs. 5% on placebo, and 11% in schizophrenia trials vs. 4%.8
Can Zoloft cause akathisia?
It can, though less often than antipsychotics. SSRIs, including sertraline, have been linked to akathisia, and the Zoloft label lists it among reports after approval.14,15
Can Wellbutrin cause akathisia?
Yes. In controlled trials of bupropion, akathisia was reported in 2% of people vs. 1% on placebo.13
How long does akathisia last?
Acute akathisia often improves once the drug is lowered or changed, though it can take weeks to months to settle. Withdrawal akathisia usually resolves within 6 weeks. Chronic and tardive forms can last months or years.1,2
Are there natural treatments for akathisia?
Vitamin B6 helped in small, short trials and is considered when other options fail, under medical guidance.3,19,20 The most important step is a medication review with your prescriber. Supplements don’t replace medical care.
Why do so many different drug classes cause akathisia?
The exact reason isn’t known. Dopamine blockade is the leading theory, but serotonin, norepinephrine, and GABA also seem to be involved, which may explain why antipsychotics, antidepressants, and stimulants can all cause it.2,22

Sources:

1. Patel J, Marwaha R. Akathisia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Updated July 24, 2023. [cited 2026 Oct 20]

2. Salem H, Nagpal C, Pigott T, Teixeira AL. Revisiting Antipsychotic-induced Akathisia: Current Issues and Prospective Challenges. Curr Neuropharmacol. 2017;15(5):789-798. doi:10.2174/1570159X14666161208153644. PMID: 27928948. [cited 2026 Oct 20]

3. Pringsheim T, Gardner D, Addington D, et al. The Assessment and Treatment of Antipsychotic-Induced Akathisia. Can J Psychiatry. 2018;63(11):719-729. doi:10.1177/0706743718760288. PMID: 29685069. [cited 2026 Oct 20]

4. Thomas JE, Caballero J, Harrington CA. The Incidence of Akathisia in the Treatment of Schizophrenia with Aripiprazole, Asenapine and Lurasidone: A Meta-Analysis. Curr Neuropharmacol. 2015;13(5):681-691. doi:10.2174/1570159×13666150115220221. PMID: 26467415. [cited 2026 Oct 20]

5. Thippaiah SM, Fargason RE, Birur B. Struggling to find Effective Pharmacologic Options for Akathisia? B-CALM! Psychopharmacol Bull. 2021;51(3):72-78. PMID: 34421146. [cited 2026 Oct 20]

6. Zareifopoulos N, Katsaraki M, Stratos P, et al. Pathophysiology and management of Akathisia 70 years after the introduction of the chlorpromazine, the first antipsychotic. Eur Rev Med Pharmacol Sci. 2021;25(14):4746-4756. doi:10.26355/eurrev_202101_26386. PMID: 34337722. [cited 2026 Oct 20]

7. Gerolymos C, Barazer R, Yon DK, et al. Drug Efficacy in the Treatment of Antipsychotic-Induced Akathisia: A Systematic Review and Network Meta-Analysis. JAMA Netw Open. 2024;7(3):e241527. doi:10.1001/jamanetworkopen.2024.1527. PMID: 38451521. [cited 2026 Oct 20]

8. AbbVie. Vraylar (cariprazine) prescribing information. DailyMed, U.S. National Library of Medicine. [cited 2026 Oct 20]

9. Otsuka. Abilify (aripiprazole) prescribing information. DailyMed, U.S. National Library of Medicine. [cited 2026 Oct 20]

10. Sunovion. Latuda (lurasidone) prescribing information. DailyMed, U.S. National Library of Medicine. [cited 2026 Oct 20]

11. Otsuka. Rexulti (brexpiprazole) prescribing information. DailyMed, U.S. National Library of Medicine. [cited 2026 Oct 20]

12. Eli Lilly and Company. Prozac (fluoxetine) prescribing information, section 5.1. DailyMed, U.S. National Library of Medicine. [cited 2026 Oct 20]

13. Wellbutrin XL (bupropion) prescribing information. DailyMed, U.S. National Library of Medicine. [cited 2026 Oct 20]

14. Pfizer. Zoloft (sertraline) prescribing information, postmarketing experience. DailyMed, U.S. National Library of Medicine. [cited 2026 Oct 20]

15. Lane RM. SSRI-induced extrapyramidal side-effects and akathisia: implications for treatment. J Psychopharmacol. 1998;12(2):192-214. doi:10.1177/026988119801200212. PMID: 9694033. [cited 2026 Oct 20]

16. Seemüller F, Schennach R, Mayr A, et al. Akathisia and suicidal ideation in first-episode schizophrenia. J Clin Psychopharmacol. 2012;32(5):694-698. doi:10.1097/JCP.0b013e3182677958. PMID: 22926606. [cited 2026 Oct 20]

17. Kalniunas A, Chakrabarti I, Mandalia R, Munjiza J, Pappa S. The Relationship Between Antipsychotic-Induced Akathisia and Suicidal Behaviour: A Systematic Review. Neuropsychiatr Dis Treat. 2021;17:3489-3497. doi:10.2147/NDT.S337785. PMID: 34887662. [cited 2026 Oct 20]

18. Poyurovsky M, Pashinian A, Weizman R, Fuchs C, Weizman A. Low-dose mirtazapine: a new option in the treatment of antipsychotic-induced akathisia. A randomized, double-blind, placebo- and propranolol-controlled trial. Biol Psychiatry. 2006;59(11):1071-1077. doi:10.1016/j.biopsych.2005.12.007. PMID: 16497273. [cited 2026 Oct 20]

19. Lerner V, Bergman J, Statsenko N, Miodownik C. Vitamin B6 treatment in acute neuroleptic-induced akathisia: a randomized, double-blind, placebo-controlled study. J Clin Psychiatry. 2004;65(11):1550-1554. doi:10.4088/jcp.v65n1118. PMID: 15554771. [cited 2026 Oct 20]

20. Miodownik C, Lerner V, Statsenko N, et al. Vitamin B6 versus mianserin and placebo in acute neuroleptic-induced akathisia: a randomized, double-blind, controlled study. Clin Neuropharmacol. 2006;29(2):68-72. doi:10.1097/00002826-200603000-00002. PMID: 16614537. [cited 2026 Oct 20]

21. Lohr JB, Eidt CA, Abdulrazzaq Alfaraj A, Soliman MA. The clinical challenges of akathisia. CNS Spectr. 2015;20 Suppl 1:1-14. doi:10.1017/S1092852915000838. PMID: 26683525. [cited 2026 Oct 20]

22. Musco S, McAllister V, Caudle I. Dopamine-receptor blocking agent-associated akathisia: a summary of current understanding and proposal for a rational approach to treatment. Ther Adv Psychopharmacol. 2020;10:2045125320937575. doi:10.1177/2045125320937575. PMID: 32922732. [cited 2026 Oct 20]

23. Pfizer. Xanax (alprazolam) prescribing information, section 9.3 Dependence. DailyMed, U.S. National Library of Medicine. [cited 2026 Oct 20]

24. Forcen FE, Matsoukas K, Alici Y. Antipsychotic-induced akathisia in delirium: A systematic review. Palliat Support Care. 2016;14(1):77-84. doi:10.1017/S1478951515000784. PMID: 26087817. [cited 2026 Oct 20]

25. U.S. Food and Drug Administration. MedWatch: The FDA Safety Information and Adverse Event Reporting Program. [cited 2026 Oct 20]

26. 988 Suicide and Crisis Lifeline. 988lifeline.org. [cited 2026 Oct 20]

Originally published May 6, 2021 by Diane Ridaeus. Rewritten October 2026.


This content has been reviewed and approved by a licensed physician.

Dr. John Motl, M.D.

Dr. Motl is currently certified by the American Board of Psychiatry and Neurology in Psychiatry, and Board eligible in Neurology and licensed in the state of Arizona.  He holds a Bachelor of Science degree with a major in biology and minors in chemistry and philosophy. He graduated from Creighton University School of Medicine with a Doctor of Medicine.  Dr. Motl has studied Medical Acupuncture at the Colorado School of Traditional Chinese Medicine and at U.C.L.A.

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Medical disclaimer

This article is for educational purposes only and does not provide medical advice, diagnosis, or treatment. Never start, stop, or change a prescription medication without consulting a qualified healthcare professional who understands your medical history. If you are experiencing an immediate medical or safety emergency, call 911.