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Forum Name: Psychiatric Topics

Question: Akathisia


 littlemiss_2075 - Mon Jan 08, 2007 2:40 pm

I took metoclopramide nightly for about three months. I would get restless but take benadryl to make those symptoms subside. One day I woke up and the restless feeling gre worse and I stopped taking the metoclopramide. I can't see my doc for another week. I am pretty sure I have akathisia. Please let me know what can be done for this, why it is still happening even though I am off my meds for 2 weeks now, if I am given meds will that 'cure' it, or will I be on meds for ever? Which meds are used. POlease help ready to go insane with feelings inside, please give as much info as you know about med induced akathisia that won't go away after stopping meds Thank you
 Dr. K. Eisele - Tue Jan 09, 2007 12:59 am

User avatar littlemiss_2075:

I'm so sorry you've had to experience this. It is extremely uncomfortable. Assuming that you do have akathisia, there are reasons why you still have it and there are many ways to deal with it.

Akathisia is the kind of syndrome that can get worse if the medication responsible for it is stopped suddenly. This should be a temporary situation, however.

Ways to deal with akathisia include medications from the benzodiazepine class (clonazepam usually), the beta-blocker class (metoprolol usually), or even one of the anti-Parkinsonian class (pramipexole, Requip, carbidopa/levodopa), and of course the anticholinergic class which you have already tried (Benadryl).

You will definitely want to discuss this side effect with your physician. Did you try calling in to report this adverse effect? Your doctor may opt to call in a prescription for you, although I have no idea if that's a possibility or not; it's just an idea.

Good luck to you in getting help for this condition very soon. Please do come back and let us know how are you doing.
 littlemiss_2075 - Wed Jan 10, 2007 8:25 pm

Thank you Dr for replying it really helped. My doctors appointment was tonight, and my doctor was reluctant to tell me I had akathisia, he said it was really rare for metoclopramide to cause this and that after about 1-2 days it would be out of my system and I wouldn't feel any restlessness from it. I was so upset I started to cry. He thinks I have anxiety. I know what anxiety feels like, and I know this is not it. I am almost 100% sure it is Akathisia. How do I get a diagnosis. I cannot go on like this. Please let me know if there is anything else I can do. Frustrated, thank you again,
Carolee

 Dr. K. Eisele - Fri Jan 12, 2007 12:57 am

User avatar littlemiss_2075:

I'm sorry you're still not feeling well. I understand how frustrating akathisia can be. I happened to be talking to a colleague about this topic today.

What is the reason you take metoclopramide? Is it for an ulcer?

I may have an idea for you, so please answer as soon as possible.
 littlemiss_2075 - Sun Jan 14, 2007 4:48 pm

Hello thanks for responding. I have been taking ativan. I am not liking it very much because it makes me feel sick and stoned and I don't like when I come down from it. I was taking metoclopramide for nausea. I haven't taken it in weeks and the symptoms are still there. when the ativan wears off the symptoms come back. My doctor thinks it is anxiety. I can feel this as rrestless legs really really badly, and also a restless feeling in my chest liek I want to scream and I cannot take it. I am glad to have the ativan but am getting worried that the symptoms will not go away. Am I just anxious? I know my body pretty well and this doesn't feel like anxiety to me. What are your ideas? Thank you!
 Dr. K. Eisele - Mon Jan 15, 2007 1:32 am

User avatar littlemiss2075:

A restless feeling in your chest sounds more like anxiety.

About the restless legs problem, a colleague was telling me that some of his patients with restless legs/akathisia have done very well by taking ibuprofen and acetaminophen together.

I asked about whether or not you have an ulcer because if you do, you MUST NOT take ibuprofen, because it can make them worse very quickly.

I think you most likely have restless legs, not akathisia, and anxiety as well. Akathisia should have gone away by now, unless you are taking another medicine that might cause it. Other common offenders are any of the antipsychotic medications, or some of the other anti-nausea meds.

Sometimes, people get restless legs "out of the blue." It may be that the metoclopramide made you more likely to get restless legs syndrome (RLS).

If you can stomach ibuprofen and acetaminophen and have no reasons (pre-existing medical conditions, other medications that would interact, etc.) not to take either, you might want to try it.

Good luck.
 littlemiss_2075 - Thu Jan 25, 2007 1:04 pm

Hi, Ok, so I haven't been able to get on this site and I hope this works because I keep getting booted out. I wrote awhile back about my akathisia symptoms. I have continued to get these symptoms and you thoughtmaybe it could be anxiety.
Is it possible that I could have anxiety when my symptoms started around 30 days ago...they last 24 hours a day with no rest. I am not consciously worried about anything. My symptoms all feel physical. The one symptom that has me concerned about this all, is my rapid heart beat. My heart rate isn't above 100 beats per minute, but it is about 15 beats faster than it normally is. I feel sick and nauseated, more tired than usual. I guess you could call it a restless feeling which I thought was akathisia, but could be anxiety or retslessness. I just don't feel right. I almost feel shaky as well. Like my hands are going to tremor or something. I feel as though my body is going through something and I cannot explain it. I truly do not feel it is anxiety. Please let me know if it coul dbe anything else, and if it is anxiety how this could happen out of the blue, persisting every minute of every day when i am as calm as could be an dhave nothing to worry about. I am starting to worry about tumours on my adrenal glands causing this, my thyroid ( my weight is ok though ). I don't know how my blood pressure is, and my doctor is on vacation for th enext week, and he is just really stuck on diagnosing me as anxious and will not listen to me. I know my body something is up...Please help.
PS- Ativan seems to help, but it seems as though the minute it starts to wear off my sysmptoms reappear? It just doesn;'t fit its anxiety. I know Iam rambling now. But I feel like I have to explain myself to get someone to listen. Thanks for listening!
 jrlpc - Fri Jan 26, 2007 6:35 pm

littlemiss,

I'm not a physician so I would prefer to let Dr. Eisele answer this one. However, I do suggest getting back in to see your doctor as soon as possible. I always tell people to listen to their body, it knows what it is talking about. If you think that you have something more than anxiety, explain that to your doctor and if he doesn't listen, then it is okay to go get a second opinion elsewhere.

I am not qualified to answer anything about tumors or any other medical field besides therapy based stuff, but you might want to check out the other psychiatry board or other medical boards on this site.

Like always, if you feel you are in danger in anyway, call 911 or go to the nearest Emergency Room.

Take care,
 Dr. K. Eisele - Sun Jan 28, 2007 9:09 pm

User avatar LittleMiss 2075:

I think you became anxious when the akathisia symptoms began, which could have been due to the metoclopramide. It is possible that the akathisia progressed to restless legs syndrome. which could be a more prolonged problem.

Your anxiety over this extremely unpleasant set of symptoms is understandable.

However, you now have so many concerns, all or any of which could explain your symptoms, I think the only prudent thing for you to do at this point is get a second opinion. At the point where you are panicked about multiple organ failure, tumors, and the like, the only way to relieve your symptoms of anxiety will be a thorough medical examination.
 littlemiss_2075 - Wed Mar 07, 2007 6:36 pm

Dr.
I have been taking zoloft and am up to 75. The symptoms which I thought were akathisia are still there. I have had blood work done and things seem ok. I did some research and found that vitamin b deficiency can cause symptoms. So I took a vitamin b complex and for the first time had total relief from the restless feeling. The vitamin however made me very sleep, nasueaus and gave me a headache, but I continued on. It lasted about 5 or 6 days of relief and my symptoms are back. Is it possible that I am having trouble absorbing it and need extra high doses? My doctor once again doesn't seem to know alot about vitamins, but I am told doctors arent that aware too indepthly abou tthem. I was hoping to get answers here. I really need relief from this restlessness, it has been months. I almost feel weak in the chest area, and I don't know, it is weird. I thought it was akathisia, I think I was wrong. Please let me know what you know about vitamin b deficiencies, or direct me to someone I could talk to fairly soon about it. My next doc appointment isn't for another week. Thank you so much for your patience an dtime
Carolee
 littlemiss_2075 - Wed Mar 07, 2007 6:54 pm

Also magnesium deficiency? Any deficiency- I have bad IBS and am a vegetarian, so I might be deficient in som estuff, thanks again.
 Dr. K. Eisele - Fri Mar 09, 2007 2:13 am

User avatar Carolee:

Vitamin B-12 deficiency is a common cause of neuropathy, a general term for nerve dysfunction. Vitamin B-12 deficiency can manifest in many ways, but there are characteristic neurologic symptoms:

    --parasthesias = abnormal sensation, particularly numbness and tingling, but could also feel like burning or prickling
    --ataxia = difficulty with balance and walking
    loss of vibration and position sense
    --can progress to severe weakness, spasticity, clonus (rapid contraction and relaxation of muscles), paraplegia, fecal and urinary incontinence

Magnesium deficiency can also cause neuromuscular symptoms:

    --generalized weakness
    --apathy (patient doesn't care about anything)
    --loss of appetite
    --delirium (mental status fluctuations with disorientation, inability to recognize familiar faces, etc.)
    --coma
    --seizures

    It is possible to overdose on vitamins. Be very careful about taking megadoses of supplements because they can be harmful. An overdose of magnesium can cause serious cardiovascular complications, such as heart attack. Vitamin B-12 overdose would be very unusual. However, vitamin supplements rarely come with just vitamin B-12. They tend to come as "B complex" supplements, which include many subtypes of vitamin B. Too much niacin (vitamin B-3) for example, causes a very unpleasant reaction, which may include symptoms of flushing, nausea, vomiting, itching, hives, constipation, and liver toxicity. Vitamin B-6 toxicity can result in peripheral neuropathy, dermatoses, photosensitivity, dizziness, and nausea.

    A nutritionist might be a better source of information that is more in depth.

    Good luck!

 littlemiss_2075 - Fri Mar 23, 2007 3:14 pm

Hi, It i sme back again. I want to thank you for your patience, and come with an update. My cortisol levels came back high. I am going for further testings blood and urine. I have a feeling it could be cushings, or something wrong with my adrenals, with the symptoms I have been getting. I feel I am finally starting to get answers. Thank you so much, I am however terrified I have adrenal cancer now ( I don't have normal wieght gain that most cushings have, so I am nervous ) but at least I am on a direction to some answers for myself, thanks again Dr,
Carolee

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