A side effect you’ve never heard of

Feb.02 I developed muscle spasms around my eyes. (Dystonia)

May 2002 GP gave me a drug (Sertraline). After two weeks I went back to him and said ‘Why are you giving me this? It says it can make twitches worse, and now I can’t sleep.’

He gave me another drug (Amitriptyline) saying ‘This will make you sleep’. I only took it for 2 days. I was sleeping perfectly well before the Sertraline.

Aug. 02 GP described ‘overtly anxiety type symptoms’

Sept. 02 I was ‘too fidgety’ in yoga

Oct. 02 It was like ‘torture’ trying to sit watching tv, & I felt ‘incredibly fidgety’ sitting in my writing group

It was another two years before I noticed the word “Akathisia” on a patient forum and asked what it meant. I recognized the description. There are many drugs which can cause akathisia but it is often underrecognized or misdiagosed as other conditions like anxiety or restless leg.

Unfortunately it is not specifically mentioned in either the Non-motor Symptoms Questionaire (NMSQuest) or the Unified Parkinson’s Disease Rating Scale (UPDRS).

Akathisia in Parkinson’s disease C. L. Comella, C.G. Goetz Mov Disord. 1994 Sep;9(5):545-9.

Overall, 45% of PD patients had akathisia as determined by clinical evaluation.

Restless legs syndrome , CHAUDHURI KR, APPIAH-KUBI LS , et al Journal of Neurology, Neurosurgery & Psychiatry 2001; 71: 143-146.

Misdiagnosis of RLS may occur due to nocturnal dyskinesias and akathisia in patients with Parkinson’s disease treated with levodopa.

Can We Improve The Holistic Assessment of Parkinson’s Disease? The development of a non-motor symptom questionnaire and scale for Parkinson’s disease K. R. Chaudhuri, A H V Schapira, P Martinez-Martin, R Brown, W Koller, K Sethi and D MacMahon Adv Clin Neurosci Rehabil, 2004 Sep. Vol 421 (4); 20-25 We are grateful to Pfizer Corporation for an educational grant to support this venture.

The Non motor symptoms screening questionnaire: Have you experienced any of the following in the last month?

  1. Feeling anxious, frightened or panicky

  2. Difficulty getting to sleep at night or staying asleep at night

  3. Unpleasant sensations in your legs at night or while resting, and a feeling that you need to move

They said it was safe By Sarah Boseley The Guardian Sat 30 Oct 1999

What Healy has learned during the litigation has surprised and worried him. He believes, as he always has, that Prozac is a useful anti-depressant. But there is now a mound of evidence that, in a minority of cases, it induces a strange and disturbing state of mind that can lead to violence and suicide.

This state of mind is a recognised psychiatric phenomenon, called akathisia. Akathisia was described by the Forsyths’ attorney, Andy Vickery, as a sort of jitteriness or feeling “wired”, like the effects of drinking too much strong black coffee. But on Prozac, the experience can be far more severe, sometimes leading to an inability to keep still and to restless pacing up and down.

The difficulty with a drug such as Prozac…is that patients may not spontaneously report problems.

And how are they supposed to report a side-effect, such as akathisia, that they’ve probably never heard of?

The answer to this side-effects problem, says Healy, is to draw up a checklist.

Patients in trials should be asked if they are suffering from any of a range of possible side-effects.


A Rating Scale for Drug-Induced Akathisia THOMAS R. E. BARNES

Severe akathisia. Pt. reports a strong compulsion to pace up and down most of the time. Unable to sit or lie down for more than a few minutes. Constant restlessness which is associated with intense distress and insomnia.

Akathisia can commonly be mistaken for agitation secondary to psychotic symptoms or mood disorder, antipsychotic dysphoria, restless legs syndrome (RLS), anxiety, insomnia, drug withdrawal states dyskinesia, or other neurological and medical conditions.
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