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Questions about akathisia... Duration, course, correlation with other EPS

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Alright, so I've been avoiding AAPs based on a bad akathisiatic experience on a low dose of Zyprexa (2.5 mg). But I'm actually wondering if Seroquel is worth giving a real go, since it seems to fit my depressive/anxious profile of BP (and my kidneys can't handle Li).

I have a couple of questions about akathisia that I'd like some input on...

1) Does it tend to let up on its own? If so, what's the typical duration of its course?

2) I've read that Cogentin is useful for this side effect. Is it necessary to take Cogentin for the duration of AAP treatment? Or does going on the Cogentin for a little while ease through the akathisia? (Or speed up the time to when it lets up?)

3) Is strong early akathisia predictive at all of the more worrisome types of EPS like tardive diskinesia?

4) Lastly, since I got akathisia on Zyprexa, should I expect it on Seroquel since they're similar? Or do they have different reputations for akathisa? (Maybe they hit the D-2 receptors in different ways; I can't seem to find any head-to-head comparisons on this side effect.)

Input greatly appreciated,


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I don't know how you find this out (maybe the web?) but somehow I think Seroquel has a lower incidence of problematic akathisia. Sometimes, no matter what drug you take, it just takes a while for the akathisia to relent but, truthfully, you will probably have some issues with it with just about any AAP. Cogentin does help and you may give it a try until you've been stable on the meds for a bit and then try to go without Cogentin and see what happens.

Good luck - I understand the frustration of trying to find a good med with the least amount of side effects.

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Hi cache-monkey

I take Seroquel and have taken it for a pretty long time. I don't really have a probelem with akathisia in general, although I will say this...

I do get it sometimes. That's why I take all my Seroquel at night. The Seroquel hits me, I get tired/sleepy and if I don't respond to that and get into bed, I will sometimes start getting some mild akathisia (a feeling of restlessness that emanates from the back of my neck) and it will get progressively worse...never horrible, mind you, but downright annoying until I get myself into bed and go to sleep.

Yeah, that's the weird thing. It will not keep me from going to sleep. It's like the restlessness is a signal from the brain to GO TO SLEEP. Go figure. So I don't take any substantial dose of Seroquel during the day if I can avoid it. I can take maybe 50 mg during the day to stave off anxiety without any issues.

But Seroquel doesn't really have a reputation for akathisia, generally. And in fact, it is actually used to treat some EPS and TD.

I'm just speaking for myself here, but if I wouldn't try the Cogentin until I gave the Seroquel a fair shot on its own first...it may very well be fine for you...and it may really depend on the dose you need, too.

Keep in mind that Seroquel does make most people sleepy so you'll probably end up taking it at night anyway. Good news if you struggle at all with insomnia (like me).

Boy, I sure hope you have some luck with this.



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Thanks for the responses. I guess what's most bothersome is that I had akathisia pretty bad on the low dose of Zyprexa. I suppose Seroquel's a different drug, so it might not be the same. More importantly, my pdoc just discontinued it when the akathisia set in. I.e. we never really tried Cogentin or anything like that.

Thanks again,


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