Reading the small print

How do you know that a drug causes akathisia if that term is never used to describe what is happening to you? Below are some of the words used instead.

Sinemet side effects:

Nervous System/Psychiatric



depression with or without development of suicidal tendencies,

extrapyramidal disorder




or worsening of involuntary movements/spasms.

aggressive behavior,

Domperidone – Oral Common Brand Name(s): Motilium Information last revised June 2017.

Side Effects

mental/mood changes (e.g., nervousness, irritability)

feelings of anxiety/agitation/jitteriness

restlessness/constant need to move

Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports BMJ 2016 ; 352 T.Sharma, L.Schow Guski, N. Freund, P. C Gøtzsche,

Twenty seven events were coded as emotional lability or worsening depression, although in patient narratives or individual patient listings they were clearly suicide attempts.

Thirty two of these events were coded as emotional lability or worsening of depression in the treatment emergent adverse events tables, but it was clear from the patient narratives or individual patient listings that they were in fact ideation events.

These events were increased hostility, aggressiveness, rage, or anger.

Some events were not listed as akathisia in the adverse events tables because of the coding dictionaries used.

For example, in the three sertraline trials where we had access to both the verbatim and the coded preferred terms, akathisia seemed to have been coded as “hyperkinesia” according to the World Health Organisation Adverse Drug Reaction Terminology dictionary.

.Therefore our number of akathisia events is likely to be an underestimate, as the event appeared to be have been coded under many other activation terms, such as irritability, agitation, or nervousness

What is akathisia? RxISK Medical Team Last updated: 2018

Akathisia is an emotional state caused by over 100 different drugs, primarily antidepressants and antipsychotics, but also antibiotics, anti-hypertensives and others. It causes suicidality, homicidality and other disturbances of behavior

It can range from a constant and disturbing mental unease through to an intense emotional turmoil – and mental restlessness. This can be accompanied by physical discomfort, an inability to remain still, or an obvious motor restlessness or fidgetiness.

Revisiting Antipsychotic-induced Akathisia: Current Issues and Prospective Challenges Haitham Salem, Caesa Nagpal, Teresa Pigott, and Antonio Lucio Teixeira Curr Neuropharmacol. 2017 Jul; 15(5): 789–798.

Failure to correctly identify akathisia can have catastrophic implications, since increasing severity of akathisia has been linked to the emergence and/or worsening of suicidal ideation, aggression, and violence