29 July 2021 was Prescribed Harm Awareness Day. I’M A bit late but I’d like to help raise awareness about a paRTICULAR drug-induced restlessness called akathisia. There are various references to restlessness on PDUK information pages and by paTients on the forum, but rarely is the word akathisia used. It is important for patients to know when they are suffering a drug-induced harm in order to prevent misdiagnosis/catastrophic outcomes.

MISSD Articles Page Spotlighting Akathisia During Mental Health Awareness Month May 20, 2021

“Many suicide prevention and mental health organizations fail to explain or even mention akathisia,” said Wendy Dolin, MISSD founder. Drug ads that end with warnings about an increased risk of suicidality also don’t mention it is related to akathisia. Such DANGEROUS SILENCE [my emphasis] is unacceptable given that keeping akathisia in the dark increases the likelihood that this critical adverse drug effect is overlooked, misdiagnosed, or mistreated.”

Tootsie Mar '13…how I have been feeling 24/7 for the past 2 years. I find this aspect of PD the most difficult to deal with. I hsve tried various things to try and calm this constant restlessness of mind and body… but I still can’t get any peace.

These are muscle movements that people with Parkinson’s can’t control. They can include twitches, jerks, twisting or writhing movements, and restlessness.

CARING for your patient with Parkinson’s Information for ward staff PDUK 2019
If a person is dyskinetic they may find it difficult to keep still and may have the urge to keep walking around the ward area. Their restlessness may be due to too much medication

Thinking about advanced pARKINSON’S PDUK Sept. 2018
Side effects of Parkinson’s medication…a feeling of restlessness and a need to keep moving.

Akathisia in idiopathic Parkinson’s disease. Lang AE, Johnson K. Neurology. 1987 Mar;37(3):477-81.

The term “akathisia” (from the Greek, meaning “not” + “sitting still”) was introduced by Haskovec to describe the inner restlessness and inability to remain still experienced by patients with Parkinson’s disease… Unlike the restless leg syndrome, this was unaccompanied by crawling sensations in the legs and not only was limited to difficulties lying still but also prevented standing and sitting still.

Akathisia In Parkinson’s Disease: Frequency And Clinical Implications Aykaç, Ö., Akbostanci, C.M., Mercan, N.F., Karan, O. MDS 17th International Congress of Parkinson’s Disease and Movement Disorders, Vol.28, June 2013

Akathisia is a feeling of inner restlessness that is relieved by moving about, causing inability to stand still. Akathisia is reported to be frequent (up to 46%) in PD, and associated with anxiety and suicidality in several diseases (an aspect which has never been investigated in PD)… so every patient with PD should be questioned about the existence of akathisia, a potentially treatable condition.
Suicidality, violence and mania caused by selective serotonin reuptake inhibitors (SSRIs): A review and analysis P.R. Breggin International Journal of Risk & Safety in Medicine 16 (2003/2004) 31–49 31 IOS Press

7.1. The Diagnostic and Statistical Manual of Mental Disorders (1994, 2000)
The capacity for SSRIs to induce akathisia – and for akathisia to cause suicidality, aggression, and a worsening mental condition – are also recognized in the DSM-IV [2] and the DSM-IV-TR [3] in the section dealing with neuroleptic-induced akathisia. DSM-IV-TR observes, “Akathisia may be associated with dysphoria, irritability, aggression, or suicide attempts.” It also mentions “worsening of psychotic symptoms or behavioral dyscontrol.”
FDA finally concedes antidepressant suicide risk after 13-year fight for warning March 25, 2004

“Through our litigation over the past 13 years, we’ve seen the internal documentation that shows the drug companies have known that their drugs can cause suicide and violence even before the drugs were approved for marketing. Moreover, both the FDA and drug companies have known that these drugs are only marginally effective in treating depression, thus the perception that the benefits outweigh the risks is based on misleading promotion of the drugs’

“It should be emphasized that, for the first time the FDA has acknowledged that the suicidal risk ‘might be a result of drug therapy,’ rather than blaming the ‘underlying disease.’ This should alert doctors that the reactions their patients are experiencing such as suicidality, agitation, akathisia, and hostility may be due to the drug. Increasing doctors’ awareness of these reactions will save lives.”