Akathisia remains an ongoing problem, despite the greater use of second-generation antipsychotics. The exact mechanism of development remains poorly understood, although ongoing research points to a greater involvement of other neurotransmitter systems outside of dopamine, such as acetylcholine, serotonin, and GABA. From this new theoretical foundation, treatment strategies have moved beyond longstanding regimens (eg, beta-blockers, anticholinergics, benzodiazepines) by including serotonin-based pharmacotherapy (eg, mirtazapine, mianserin). Based on akathisia’s similarity to movement disorders such as RLS, new approaches under investigation include medications that increase dopamine and GABA (eg, ropinirole, gabapentin, pregabalin, vitamin B6), which are depleted with neuroleptic use. Timely diagnosis and adequate treatment are key in maintaining patient rapport, improving medication compliance, and increasing efficacy. Thus, providers need to be aware of this phenomenon and understand how to manage it effectively using the latest research-supported treatment regimens (Table 1).
Table 1.
Treatment Recommendations