Is it anxiety or akathisia?

Work out your own timeline. Did you experience the symptoms before taking drugs or only after starting them?

Beyond anxiety and agitation: A clinical approach to akathisia R.O.Tachere , M.Modirrousta Australian Family Physician Vol.46, No.5, 2017 P. 296-298

When patients suddenly become restless and are unable to sit or stand still, especially in general medical settings, anxiety is often the topmost differential on every clinician’s mind. However, the possibility of the very subjectively distressing condition called ‘akathisia’ should always be considered.

Akathisia or Anxiety: What is the Difference? [P.Serrano](file://localhost/javascript/void(0)%3B), [P. Musunuri](file://localhost/javascript/void(0)%3B), March 2017 Vol.25, Issue 3, Supplement, Pages S82–S83 American Journal of Geriatric Psychiatry

Akathisia is a medication-induced movement disorder often described by patients as restlessness or an inability to stay still. It is often interpreted as anxiety and insomnia. If the symptoms are severe enough, the agitation that it causes may be treated with neuroleptic medication that can worsen the condition if it hasn’t been properly identified.

Akathisia: overlooked at a cost H.Akagi, T. M. Kumar , BMJ 2002;324:1506-1507 ( 22 June )

Patients often find it difficult to explain the inner restlessness or mental unease, and the condition may easily be interpreted as acute anxiety or depression. Therefore diagnosis relies on a high index of suspicion on the part of the clinician. Thus when patients present with acute symptoms of agitation and restlessness, their medication should first be checked for a recent introduction or increase in the dose of drugs associated with akathisia.

There may be a history of previous similar episodes, as in all our cases, which will help in the diagnosis.

Madopar Package leaflet: Information for the patient. last revised 10/3/16 Roche Products Limited

Undesirable effects include: Depression, Agitation, Anxiety, Insomnia, Dyskinesia (choreiform and athetotic), Restless legs syndrome

Movement disorders associated with the serotonin selective reuptake inhibitors . Leo RJ.J Clin Psychiatry. 1996 Oct;57(10):449-54.

Among the 71 cases of SSRI-induced EPS reported in the literature, the most common side effect was akathisia (45.1%), followed by dystonia (28.2%), parkinsonism (14.1%), and tardive dyskinesia-like states (11.3%). Among patients with Parkinson’s disease treated with SSRIs, there were 16 cases of worsening parkinsonism. Patients who developed dystonia, parkinsonism, or tardive dyskinesia were older on average than patients with akathisia; 67.6% of affected patients were females. Fluoxetine [Prozac], the most commonly prescribed SSRI to date, was implicated in 53 (74.6%) of cases of SSRI-induced EPS. Several reports (57.7%) were confounded by the concomitant use of other medications that can contribute to the development of EPS.

Nonmotor fluctuations in Parkinson’s disease: frequent and disabling. Witjas T, Kaphan E, Azulay JP, Blin O, Ceccaldi M, Pouget J, Poncet M, Chérif AA. Neurology. 2002 Aug 13;59(3):408-13.

All patients [50] had had at least one type of NMF, most of which were associated with the "off" state.

Anxiety (66%), drenching sweats (64%), slowness of thinking (58%), fatigue (56%), and akathisia (54%) were the most frequent NMF.

Restless Legs Syndrome K. R.Chaudhuri, D. Rye & L.Ferini-Strambi OUP 2009

Chapter 5 Differential diagnosis of restless leg syndrome K.R.Chaudhuri, D.Rye, and S Muzerengi

Akathisia is a drug-induced adverse effect and therefore it is treated by gradually decreasing the dose of the offending agent and thus restoring dopaminergic function…Furthermore akathisia can be precipitated by dopaminergic drugs such as levodopa in dopamine deficiency disorders such as Parkinson’s disease.

Movement Disorders in Clinical Practice K Ray Chaudhuri, William Ondo Springer 2010

Other movement disorders W.G.Ondo

Drug-induced movement disorders remain a common and under-recognized problem. Blockade of the dopaminergic system results in multiple syndromes… These syndromes are often referred to as extrapyramidal side effects (EPSE) and include tardive dyskinesia, acute dystonic reactions, akathisia, drug-induced parkinsonism and neuroleptic malignant syndrome. Serotonin syndrome and drug-induced tremor are also briefly discussed.

link for full text of akagi article:

Akathisia: overlooked at a cost H.Akagi, T. M. Kumar , BMJ 2002;324:1506-1507 ( 22 June )