Why Must We Stop Gaslighting People With Medication Induced Akathisa?

Why Must We Stop Gaslighting People With Medication Induced Akathisa?

What exactly is iatrogenic akathisia?

Akathisia is a movement disorder, possibly related to subcortical excitation, that is experienced as a feeling of inner restlessness. Some people who suffer from akathisia describe it as an internal itching.

The condition is characterized by dysphoria, motor restlessness, pacing back and forth, movement of the limbs, and insomnia. While the word “akathisia” is similar to kathisophobia, a fear of sitting, the conditions are not at all related.

It is impossible for someone who has not experienced akathisia to relate to the sense of terror that can accompany the persistent and relentless symptoms. Akathesia can cause a level of despair that causes sufferers to experience suicidal ideation.

Some descriptions of akathisia include a feeling of the skin crawling, or even a feeling of wanting to peel away the skin and jump out. The condition is terrifying and can feel hopeless.

What is the best way to land an airplane, and why is it a bad idea to quit psych drugs cold turkey or taper too quickly?

The answer to this question about landing an airplane probably differs, depending on the type of plane, the runway, the weather, and many other factors. One thing that we can all agree upon is that the wrong way to land an airplane is by flying straight down, into the ground.

The primary goal in landing is to cause the least trauma and damage possible. It is common sense that a gradual, carefully controlled descent is the best way to land safely.

A common theme in detoxing a person off of a drug on which they have become dependent is to do so gradually, just like landing an airplane. Coming in for a landing too quickly, and too steeply, increases the risk of harm.

Quitting a drug cold turkey, where there is physical dependence, is like crashing the plane straight down, into the ground. Trauma is almost inevitable.

Does quitting a benzodiazepine too quickly cause akathisia?

The most important cause of akathisia to be aware of is psychiatric drugs. It is most often associated with quitting a drug cold turkey, or tapering off of the drug too quickly.

Some drugs connected to akathisia include selective serotonin reuptake inhibitors (SSRIs), such as Lexapro, Paxil, Prozac, and Zoloft. Treatment with neuroleptic drugs may also lead to patients experiencing akathisia.

Benzodiazepines are closely associated with the risk of developing akathisia. Quitting a benzo cold turkey, or being detoxed quickly off of a benzo can lead to acute akathisia or chronic akathisia. For more information, please visit the Benzodiazepine Information Coalition’s page on Akathisia.

Why would a person quit a benzodiazepine by tapering very quickly or by quitting cold turkey? One common culprit is the detox and rehab industry.

Many people do not understand that most benzodiazepine use is not addictive drug use.

A person who takes a benzo for many years will typically develop a physical dependence, but not an addiction. Drug addiction is characterized by obsession with the drug, a compulsion to keep taking more, and self-harm with a loss of self-control. Typical benzo use rarely causes a person to become addicted, only dependent.

When a person quits taking a benzo suddenly, they may experience significant withdrawal symptoms, including, possibly, withdrawal akathisia. This medication induced akathisia can be terrifying, and it can be long-lasting.

Unfortunately, rehab and detox facilities are often not sensitive to the difference between addiction and physical dependence. The goal of a detox, or rehab, is to get the client off of the offending substance as fast as possible, with little or no tapering.

Another aspect of rehab that makes the treatment of benzodiazepine dependence treatment problematic is the fact that clients are not trusted. Everything out of the mouth of a rehab client is considered to be some sort of lie aimed at getting more of their substance of choice into their system.

There is an old rehab joke, that is somewhat offensive, that goes like this: “How do you know when an alcoholic/addict is lying? When their lips are moving!” You can imagine how a benzodiazepine dependent person admitted to rehab might become a victim of gaslighting, being told that their symptoms are not real, or worse, they are lying to get more drugs.

Ideally, a patient dealing with benzodiazepine side effects and benzodiazepine withdrawal should see a doctor familiar with both addiction treatment and psych drug dependence treatment. It is important that the doctor is familiar with topics, such as the Ashton Method and symptoms of benzo withdrawal, such as benzo belly.

Is akathesia caused by GABA downregulation or toxic encephalopathy (TE)?

Benzodiazepines work on the GABA receptors in the brain. Imagine a valve in the neuron with the neurotransmitter, GABA, pouring in, and the benzodiazepine receptor is an adjustment knob on that valve.

In general, the theory of receptors in the human brain and body is that, when a substance from outside the body is repeatedly introduced that stimulates a receptor in the body, there will be a change that happens over time. The body will reduce the number of receptors, or it will reduce the amount of natural organic molecules within the body that activate those receptors, or both. This is known as downregulation.

Downregulation in the brain, generally meaning less neurotransmitter, or fewer receptors, is the cause of physical dependence on psych drugs, such as benzodiazepines. The brain needs time to adjust and get the amount of receptors and neurotransmitters back to the normal amount that existed before the drug was introduced.

Tapering a drug, or gradually reducing the dosage over time, is thought to be the best way to give the brain time to adjust.

By tapering the dosage slowly, the brain has time to appropriately increase the amounts of receptors and neurotransmitters. Another theory is that of traumatic encephalopathy (TE), which simply means damage to the brain due to trauma. Some experts believe that psych drugs, and the sudden removal of them, cause actual damage to the brain, at the level of the individual neurons.

So, is akathisia caused by TE or a reaction to receptor downregulation, or a combination of both? The role that each mechanism plays is still under investigation.

The way that patients are tapered off of benzodiazepines over time may be adjusted to be shorter, in general, if TE is found to play a greater role. In fact, benzodiazepine prescribing in general, will have to be reduced, or almost completely eliminated, if the benzodiazepines are found to be toxic to the brain.

Additionally, there is a neuroadaptive process known as kindling, which is related to GABA and glutamate, which can put a person who has withdrawn repeatedly from benzodiazepines at higher risk for seizures and related issues.

How is akathisia evaluated by doctors?

Not all cases of akathisia are the same. Some people have a persistent feeling of restlessness, and others have severe akathisia, with difficulty sitting or staying still, and a constant feeling of terror.

There are many possible manifestations of akathisia, including dysphoria, frantic speech, insomnia, a feeling of impending doom. The Barnes Akathisia Rating Scale (BARS) is a set of criteria that can be used by doctors to assess a patient with akathisia, to determine the level of severity.

While the Barnes scale is highly useful in documenting akathisia, in many cases, we must first educate doctors that iatrogenic movement disorders of this kind do exist. Doctors must learn to differentiate medication induced akathisia from a factitious disorder, functional neurological disorder, bipolar disorder, or depressive disorder, or even from other movement disorders.

Many patients with akathisia present to the emergency medicine department, concerned about what is happening to them and what they can do to feel better. Unfortunately, ER visits can lead to misdiagnosis and prescribing of more psych drugs that can lead to more problems, including worsening drug induced akathisia.

What can be done about akathisia and akathisia symptoms?

Akathisia is a terrifying condition that has led many sufferers to feel suicidal and suicide attempts. The feeling agitated, terror, an inability to sit still, stop moving, or sleep, can give a person a sense of hopelessness.

Being a victim of gaslighting makes things worse. When doctors and family members interpret the symptoms of akathisia as signs of schizophrenia, depressive symptoms, or other mental health problems, or even addiction, the problem is only made worse.

Going to rehab for an addiction problem, or the psych ward for mental illness are among the worst things that can be done to treat akathisia. Patients will actually feel better and function better when they are understood and believed.

Akathisia, whether it is neuroleptic induced akathisia, SSRI induced akathisia, or benzodiazepine induced, is a real condition. There are real physical changes at the level of the neurons of the central nervous system that result in this syndrome.

Medications are usually not a good idea, when treating akathisia.

While medications are generally not recommended for the treatment of akathisia, since meds caused the problem in the first place, doctors do sometimes prescribe medications to help with symptoms. For example, the beta blocker, propranolol, may help with physical symptoms, and mirtazapine may help with sleep, in some cases.

The most important start to helping a person who has akathisia is for the doctors involved in the case to get educated on the condition and make it clear to the patient that they understand that akathisia is a real neurological disorder and that it is extremely unconfortable. Family members must also learn about the condition and offer their support, understanding that akathisia is real, and it is very difficult to endure.

When the patient occasionally lashes out verbally at family members, they should keep in mind that their loved one is suffering and that responding with caring and compassion is the best way to help out. While living with akathisia is not easy, it does improve over time.

Are there any activities that can help a person to better tolerate akathisia?

Controlled aggression is one way that a person can feel better while experiencing an exacerbation of akathisia symptoms. Controlled aggression means to taking anger in a way that the patient and people around them are not harmed.

For example, a patient could obtain a punching bag or punching dummy to use as needed. Of course, safe punching is important. Keeping the thumb out of the fist can prevent serious injuries while punching in controlled aggression sessions.

Another technique is to scream into a pillow. It is recommended, when screaming to get out the frustration caused by akathisia, that the person alert others in the home, so they are not alarmed by the noise, and they won’t call for emergency services accidentally.

Pacing back and forth is a hallmark symptom of akathisia. Some experts recommend walking long distances to induce fatigue. This will help to reduce akathisia symptoms and to help the person to get some sleep.

Is there hope for people who suffer from akathisia?

Fortunately, this extrapyramidal syndrome does not last forever. Over time, the symptoms associated with akathisia will dissapate and go away.

It is important that the patient is aware of the fact that they will get better. They must get through the difficult, sometimes very prolonged period of akathisia symptoms, but they will get past the syndrome, finally being able to live without akathisia.

The best way to address akathisia, is to prevent it in the first place. As noted earlier, akathisia is associated with discontinuing a psych drug cold turkey or tapering too quickly. Careful, gradual tapering off of a drug, such as a benzodiazepine, can make a big difference in not experiencing akathisia.

As doctors become more aware of this serious neurological syndrome, hopefully, they will not encourage patients to stop psych drugs cold turkey or to reduce them too quickly.

Once a patient has already begun to experience akathisia, supportive loving care from their family is important, as well as practicing safe activities that help to relieve symptoms.

Spiritual practices may be helpful in making akathisia symptoms more tolerable.

While it can be difficult to feel gratitude for anything while experiencing akathisia, there are often still many things to be grateful for.

If possible, gratitude therapy may help the patient to feel better about themselves and their situation. Providing service to others can also be helpful.

For example, a person who joins an akathisia support group may be able to share hope and their experiences and tips for dealing with symptoms. Peer support can be helpful for people living with akathisia.

Mindfulness may also be helpful. For example, a person may focus on being aware of nature and pleasing things in the environment.

Breath work helps some people to tolerate symptoms better, and also possibly to get to sleep. There are many courses, books, and educational materials on various types of breathwork.

Is it a good idea to join an akathisia support group?

While online support groups can be very helpful, they can also be triggering, making symptoms worse. It is not a good idea to read other people’s accounts of suffering from akathisia. When anxiety levels rise, the symptoms may worsen.

Support groups are great when there is true support, in the form of compassion, empathy, and sharing a sense of strength and hope. However, negative support groups should be avoided.

The best support group is a loving, caring family that has taken the time to learn more about akathisia and what it is like for someone to suffer with these symptoms. Support from a person’s healthcare providers is also important.

Living in a supportive, loving, caring environment helps with tolerating akathisia symptoms, and it helps with the healing process.

Most of all, it is of the utmost importance to understand that there is a healing process occurring while akathisia is present. For people who live with akathesia, the best message to bring to them on a regular basis is that there is hope, because there is healing.