Akathisia can develop subtly, so that it is sometimes not recognised straight away. That often makes the situation more complicated and confusing.
What is akathisia?
Akathisia is a movement disorder, but one that plays out more on the inside. It can occur when you start, stop or change certain medicines. People feel restless and experience intense tension, and in severe cases this can lead to despair and feelings of hopelessness. What makes it more confusing is that akathisia is not always visible to the outside world. You do not see a physical change straight away, as with a trembling leg or jerking movements. It often plays out on the inside, and the people around you do not always notice.
How do you recognise akathisia?
One of the biggest challenges is that akathisia is easily confused with other things, such as anxiety or restlessness that belong to an existing mental health problem. People with akathisia can show signs such as constant pacing, rocking on a chair, or an inner feeling of ‘moving’ without moving visibly. But the feeling often stays invisible, which can lead to misunderstandings and wrong diagnoses, with doctors and even with the person. Another risk is that doctors sometimes put this restlessness down to the original complaints and raise the dose of the medicine, which can make the problem worse.
The impact of a wrong diagnosis
Akathisia can have a serious impact on daily life and mental wellbeing. The feeling of despair and restlessness can be so intense that some people try to escape it by hurting themselves. The impact of akathisia is often underestimated. It is more than being ‘a bit restless’. It can be so overwhelming that it affects daily life and puts the ability to function under enormous pressure.
What can you do if you think you have akathisia?
If you suspect that you have akathisia, it is important to discuss this with your doctor straight away and to ask specifically whether your symptoms can be caused by akathisia.
Arm yourself with knowledge, so that you can ask the right questions and are not simply prescribed a higher dose without a good explanation. Read also why a higher dose is not always better.
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Akathisia: more than you think
The aim of this page is to create awareness of akathisia, and not to frighten you. It is a side effect that is often not understood and that deserves more attention. It is important that we open the conversation and make sure people get the right information and support.
Read more: Tips for tapering off your medication.
Do you need help now?
PsychosisNet offers information. We do not offer a chat, a helpline or crisis support. If you or someone else is in immediate danger, call the emergency number in your country. If you are thinking about suicide, or you need to talk to someone now, see Need help now? for helplines by country.
Prof. dr. Jim van Os, Chair Division Neuroscience, Utrecht University Medical Centre. Jim works at the interface of ‘hard’ brain science, health services research, art and subjective experiences of people with ‘lived experience’ in mental healthcare.
Jim has been appearing on the Thomson-Reuter Web of Science list of ‘most influential scientific minds of our time’ since 2014. In 2014 he published his book ‘Beyond DSM-5‘, and in 2016 the book ‘Good Mental Health Care’. In 2026 he published 'Wat psychisch lijden is'.
Want to read more?
Blogs by Jim van Os can be read here
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