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My pdoc bumped me up to Abilify 30 mg and it didn't take but a few days for the akathisia to set in like crazy! I am at a loss of what to do about it.

  • Benzos don't help.
  • Beta-blockers don't help.
  • The only things that help are anticholinergics, specifically, Cogentin (benztropine), but I can't stand the side effects.
    • I have never tried Artane (trihexyphenidyl) because my pdoc won't let me.
    • If anyone can vouch for this being better than Cogentin, I will see if I can call my neurologist and see if he can call some in for me.
  • I have also found that, strangely, Zomig (zolmitriptan) helps it, but I have an extremely limited supply of it.

Is there ANYTHING else for akathisia? ANYTHING? I've researched and have read that 5-HT2A antagonists are apparently beneficial, but I don't have anything that's really much of a 5-HT2A antagonist except trazodone, and that doesn't do jack for me.

On top of all this, my mood is still in the gutter for what that's worth, and the dysphoria associated with akathisia is making it much, much worse.

Please help me! I'm pacing so much there are little trails developing in the floors around my house!

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That sucks...I had the exact same issue on that med/dose. The only thing I can think of is *longshot* Benadryl. It's not first (or second) line but I had a pdoc who used it. For me the akathisia outweighed the benefits and I switched off 

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2 hours ago, Iceberg said:

That sucks...I had the exact same issue on that med/dose. The only thing I can think of is *longshot* Benadryl. It's not first (or second) line but I had a pdoc who used it. For me the akathisia outweighed the benefits and I switched off

Thanks for the input! I'm sorry though, I forgot to mention... Benadryl doesn't work either... :( It's apparently not a potent enough anticholinergic.

2 hours ago, looking for answers said:

i have no ideas, but i am hoping u find some relief @mikl_pls

Thanks @looking for answers! I appreciate it!

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4 hours ago, mikl_pls said:

 Is there ANYTHING else for akathisia? ANYTHING? I've researched and have read that 5-HT2A antagonists are apparently beneficial, but I don't have anything that's really much of a 5-HT2A antagonist except trazodone, and that doesn't do jack for me.

I've never personally experienced akathisia, but I did a little googling and found this:

https://www.ncbi.nlm.nih.gov/pubmed/8829717

I don't know much about cyproheptadine, except that it's a first gen antihistamine, and is used off- label for akathisia.......According to small study linked above, it improved akathisia in all of the 17 patients, and in 15 of the patients, akathisia was reduced to a marked degree.

Edited by CrazyRedhead
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Akathisia's atrocious.  I also got it on abilify.  The only thing that worked for me was going off the medication.  I think you mentioned the usual ones to treat it though.  I don't know enough to compare Artane to Cogentin, but I've heard both mentioned, so maybe it's worth pursuing?

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2 hours ago, CrazyRedhead said:

I've never personally experienced akathisia, but I did a little googling and found this:

https://www.ncbi.nlm.nih.gov/pubmed/8829717

I don't know much about cyproheptadine, except that it's a first gen antihistamine, and is used off- label for akathisia.......According to small study linked above, it improved akathisia in all of the 17 patients, and in 15 of the patients, akathisia was reduced to a marked degree.

Very nice! Thank you! I seem to remember seeing something about cyproheptadine being used for akathisia. I would be worried about weight gain of course seeing as it is used for an appetite stimulant, but at this point I think I'm pretty desperate. Thanks a bunch!

1 hour ago, dancesintherain said:

Akathisia's atrocious.  I also got it on abilify.  The only thing that worked for me was going off the medication.  I think you mentioned the usual ones to treat it though.  I don't know enough to compare Artane to Cogentin, but I've heard both mentioned, so maybe it's worth pursuing?

Yeah it's really horrible... worse than horrible... I wouldn't wish it upon anyone! I think I may call my neurologist tomorrow and ask if he could prescribe me some Artane just to try it... I don't know why my pdoc won't let me try it. She said something about it being addictive...

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@mikl_pls addictive? That's a new one to me- although I'm sure someone who knows more might quote me and prove me wrong....but even if it is...pdoc trusts you to get stims and benzos but is afraid of an anticholenergic? Seems like there must be more to the story there 

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Have any hydroxyzine laying around? Might be stronger than Benadryl. Or combine it with the Benadryl?

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3 hours ago, argh said:

Have any hydroxyzine laying around? Might be stronger than Benadryl. Or combine it with the Benadryl?

I forgot all about hydroxyzine! I do have some hydroxyzine pamoate (Vistaril) 50 mg I could try. I don't think I have any Benadryl, but I could purchase some. That's a good idea.

5 hours ago, Iceberg said:

@mikl_pls addictive? That's a new one to me- although I'm sure someone who knows more might quote me and prove me wrong....but even if it is...pdoc trusts you to get stims and benzos but is afraid of an anticholenergic? Seems like there must be more to the story there 

I know right? She said it causes a rush of dopamine release or something like that.

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16 minutes ago, mikl_pls said:

I forgot all about hydroxyzine! I do have some hydroxyzine pamoate (Vistaril) 50 mg I could try. I don't think I have any Benadryl, but I could purchase some. That's a good idea.

I know right? She said it causes a rush of dopamine release or something like that.

So quick research- I guess it can cause a buzz but in the same way that downing a bottle of Benadryl happens- in settings where drugs with "real" buzz properties are super uncommon such as jail. It did look like doc's tend to try cogentin first...also said like suggested above that it has synergistic effect with Benadryl or hydroxyzine. Still don't get why that  is more risky than giving a benzo 

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4 hours ago, argh said:

maybe some promethazine, if you also have that lying around?

That's a thought! I do not, though. My mom just had surgery and has some though. She is not taking it, though. I don't want to take it from her, but if she doesn't mind, I might try some. It's 25 mg. When I call my neurologist, I might see if that's an option.

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