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NIH equates akathisia with “restless leg syndrome” – and Pharma smiles upon them 03/10/2011

Posted by ALT in Pharmaceuticals.
Tags: , , ,

What does the critically thinking individual do with any doctor’s recommendation? 


Does this professional know what he’s talking about?  What have the experiences of other patients been?  What kind of scientific data is available on the recommended course of treatment?

And of course the first (and perhaps only) source of information most folks turn to is the Internet – a boon and a bane.

A big stack of books just isn't as sexy as a well-executed Google keyword search.

Granted, there’s TONS of good information available, but there is an equivalent amount of propaganda.  And depending on Google to do the filtering for you is not always a safe bet.  Why?  Because pharmaceutical companies can and do rig Google searches so that their preferred sites show up first.

Not only that; as I’ve recently discovered, government-endorsed sites (supposedly unbiased) can be just as bad. 

Exhibit A: the National Institute of Health’s [NIH] website PubMed’s page on akathisia.  If you google “akathisia,” it’s the first hit.

According to the NIH akathisia IS “restless leg syndrome; a disorder in which there is an urge or need to move the legs to stop unpleasant sensations.”  What causes it?  Well, there’s peripheral neuropathy, chronic kidney disease, Parkinson’s, iron deficiency… and then at the very end of the list is “use of certain medications.” [the implication being that the causes are listed in order of prevalence.]  Also, the NIH informs us, this disease may be genetic… though the gene has, of course, “not been identified yet.”

The NIH also claims that

Restless leg syndrome [remember, they are saying this is the same thing as akathisia] is not dangerous or life-threatening, and it is not a sign of a serious disorder.  However, it can be uncomfortable and disrupt your sleep.

(from the NIH PubMed page on akathisia)

So let’s pretend that a doctor recommended that I begin taking one of those “certain medications” that lists akathisia as a side effect – an antipsychotic, or a stimulant, an SSRI, or perhaps a mood stabilizer — and I did a little research, googling “akathisia” and clicking on the first link that came up (PubMed)I would probably think “Restless Leg Syndrome?  Well, that doesn’t sound too bad.  Glad I checked up on that.”


But what happens when those “restless legs” walk you right off a cliff?

In truth, akathisia is much more than a mere problem of “restless legs.”  It is a serious, torturous, and potentially life-threatening condition (not simply uncomfortable).  Even the DSM-IV, bastion of science that it is, says

The subjective distress resulting from akathisia is significant …  Akathisia may be associated with dysphoria, irritability, aggression, or suicide attemptsWorsening of psychotic symptoms or behavioral dyscontrol may lead to an increase in neuroleptic medication dose, which may exacerbate the problem. 

(from the Diagnostic and Statistical Manual [DSM-IV]; emphasis added)

What’s more, akathisia is most commonly caused by medications which carry it as a side effect (the other potential causes are extremely rare when it comes to true akathisia – though they may very well be linked to “restless leg syndrome”).  The link between medication-induced akathisia and suicide has been well established. In one study, it was found that 79% of mentally ill patients who attempted suicide were suffering from akathisia.  Numerous case studies show the same – akathisia causes suicidal ideation.  [citation: Drake, R. (1985).  Suicide Attempts Associated with Akathisia. American Journal of Psychiatry, 142].    

Psychiatric survivor Jack Henry Abbot describes akathisia:

These drugs… do not calm or sedate the nerves.  They attack.  They attack from so deep inside you, you cannot locate the source of the pain… the muscles of your jawbone go beserk, so that you bit the inside of your mouth and your jaw locks and the pain throbs.  For hours evey day this will occur.  Your spinal column stiffens so that you can hardly move your head or your neck and sometimes your back bends like a bow and you cannot stand up.  The pain grinds into your fiber… You ache with restlessness, so you feel you have to walk, to pace.  And then as soon as you start pacing, the opposite occurs to you; you must sit and rest.  Back and forth, up and down you go in pain you cannot locate, in such wretched anxiety you are overwhelmed, because you cannot get relief, even in breathing.

(Jack Henry Abbot, in In the Belly of the Beast)

Akathisia has also been linked to violent and homicidal compulsions in otherwise peaceful and non-violent human beings.

The pharmaceutical companies have worked hard to suppress information both about the seriousness of akathisia, and the frequent rate at which it occurs in patients taking many psychotropic drugs (one excellent example here).  Looks like the NIH is fully on board with this one…

Way to go guys!

DAMN it feels good to be a gansta.

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1. Maria Bradshaw - 03/13/2011

My 17 year old son committed suicide fifteen days after being prescribed prozac and suffering akathisia as an adverse effect of the drug. Restless leg syndrome? Try brain torture so severe that it makes a child put a noose around their neck and end their life to escape it.

altmentalities - 03/13/2011

Maria, I am so sorry. My heart goes out to you. Don’t know if there’s anything a poor mental health blogger could do to aid or support you — but all you have to do is ask.

2. Horizant: The Second Coming of Gabapentin « Thought Broadcast - 04/08/2011

[…] National Institutes of Health (NIH) web site referred to RLS as “akathisia” (thanks to altmentalities for the link).  Akathisia (from the Greek for “not sitting still”) has long been […]

3. marie katra - 06/24/2011

I was diagnosed with RLS 20 years ago. I have had ongoing depression and a few suicide attempts within the past 10 years.
Not only did I suffer from no sleep the effects of sleep deprivation
have cause me to lose my job,family and friends. i was a nurse for 25 years and they treat RLS like they treated asthma in the 1950’s and 1960’s, as if it was a pschiatric problem. It is very frustrating for others to comprehend the effects of sleep deprivation caused from RLS.

4. New “research” claiming antidepressants don’t cause suicidality in children is fraudulent « freakoutcrazy - 02/26/2012

[…] beginning, Eli Lilly executives noted Prozac’s (fluoxetine) propensity to cause agitation, aka akathisia, which research suggests is the causative factor in SSRI-related suicides.  It was recognized that akathisia put trial participants at increased risk for suicide.  This […]

5. GeoffShield - 12/13/2012

Geoff shield-14/12/12-after 15 years of RLS-ever worsening-feel I have reached end of the line-suicide looms as a ble.ssed relief.About to have to give up my good job,can’t fly or drive far,wife fed up with me,every day a real drag due incredible insomnia.-Allrecommended treatments ineffective,sceptical Doctors. Can anyone out there help me ? I have 4 kids and don’t want to leave them but feel I just can’t go on

6. Angie - 02/19/2013

I had a recent bout with akathisia following taking Risperdal for a month and a half, no doctor in the ER is capable of treating this, because they all stated that they did not know much about it, I suffered immensely and paced in front of them and I was initially diagnosed with withdrawal from the med because I stopped it two days in a row due to extreme constipation, 4 other consecutive visits to the ER, and only one doctor knew what it was but did not know how to treat it, I was given valium once, sent home on continued Risperdal, second time given benadryl and sent home to continue that and off Risperdal, which in the long run made it worse, third time was given cogentin, sent home only on stool softeners, suffered three days with recurrence of symptoms waiting to see my PCP, given more cogentin by my PCP, made the recurrences worse and more frequent and the fourth visit to the ER almost sent me home on round the clock cogentin, because the stupid doctor and physician assistant did not know how to treat me, and they stated this in my face. Finally, I told them enough is enough!!! I want a consult with neurology which they did not grant me, I got a psychiatry consult instead and finally had someone who knew what they were doing. He told me that any benadryl or cogentin makes the symptoms worse, and that these are not first line in treating akathisia. First line treatment is propranolol/inderal. I was discharged on inderal and had one really bad recurrence the second dose I took and suddenly after 3-4 hours of nonstop pacing and feeling like I was going to die, everything just stopped. I have felt better on inderal, but have had to decrease the dose due to low blood pressure. I still have horrible days, but nothing compared to those two weeks of hell. My anxiety levels are still sky high but I am able to sit and do my ADL’s every day. It is a waiting game to see if I have a recurrence. Lawyers that I contacted, are equally stupid and misinformed, telling me that I do not have a case of misdiagnosis and saying it is like RLS. More awareness needs to be brought to the public about the dangers of these symptoms and doctors and health practitioners need more training in these areas.

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