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Beta-blockers for Akathisia


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Hey, I'm relatively new to the these boards, not so much to the chat room, hopefully no one has already discussed this but I am interested in beta-blockers such as propranolol or metoprolol. I have already spoken to my psychiatrist about the use of Cogentin to combat akathisia, but her opinion and that of Wikipedia don't agree. She has told me on two different occasions that Cogentin won't work for akathisia. I have already tried the benzos Klonopin and Ativan but they did not provide much relief. I am wondering what other bipolar sufferers or people on anti-psychotics who experience akathisia have to say about this. I interested in switching back to Abilify because it is the only psych med that has ever done anything for my depression but it comes with the intolerable akathisia. She never mentioned beta-blockers after denying me Cogentin even though it was given to me while I was in the hospital. I like the relief from depression that Ablifiy provides but these beta-blockers seem like a requirement for me to be back on it. I've never met anybody on propranolol or metoprolol. Let me know what you know.

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When I was in the hospital, they recommended Cogentin (actually pretty much FORCED me to take it cause I wouldn't stop moving and was in agony). Then when I got out, my pdoc seconded that Cogentin helps Akathesia. It's not the only thing...those other things you mention probably work, as does Benadryl even, but Cogentin always worked every time. It was sort of a miracle. Only reason I don't like to take it is cause I get weird side effects from it, but I'm sure most don't.

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I took propranolol for anxiety and migraine prophylaxis but it helped to calm me down and while i didnt have akathesia it did stop me from fidgeting and being all squirmy, which i think is probably pretty much akathesia just wasnt diagnosed. I don't think it had a depressing effect on me, however I don't take it any more, and I also am a lot happier - i have no idea if these are in any way related though. Perhaps if your doctor is willing to prescribe it to you it is worth a try?

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I took cogentin for a restless leg problem caused by zyprexa. By the time I got up to a dose that worked on the legs, I started doing some crazy sleepwalking and waking up 6-7 times a night. Now, I'm not a typical case by any means. But when I started folding up my pillow in my bedspread because I thought it was a cinnamon roll and tried slicing it in pieces with my hand and wouldn't stop even though my husband kept telling me to go to bed, I knew it was time to stop the cogentin. Actually, it was the fear that I would try to go down the stairs in my house sleepwalking when I had just had knee surgery that did it.

I ended up decreasing the zyprexa and the problem "mostly" went away. I don't envy you. I was on abilify four times... got akathisia four times.

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  • 3 months later...
Guest Becckasoo

propranolol caused severe fatigue and depression with me. But did help with the akathisia...

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I have already spoken to my psychiatrist about the use of Cogentin to combat akathisia, but her opinion and that of Wikipedia don't agree. She has told me on two different occasions that Cogentin won't work for akathisia.

I tried Cogentin once for the exact same thing - Akathisia on Abilify. It's an activating med in that it raises heart rate and all that. Alot of people use it successfully to combat Akathisia. It is actually the general go-to drug for this problem, so yes, Cogentin can usually work for Akathisia. However, it doesn't work for Akathisia 100% of the time. Some people, like me, have no response to it - meaning it didn't work for my Akathisia at all. You're pdoc sounds biased.. perhaps because of her experience in her practice. It's possible that she's never seen Cogentin really work or only work rarely - but she's not completely wrong.

I have already tried the benzos Klonopin and Ativan but they did not provide much relief. I am wondering what other bipolar sufferers or people on anti-psychotics who experience akathisia have to say about this. I interested in switching back to Abilify because it is the only psych med that has ever done anything for my depression but it comes with the intolerable akathisia. She never mentioned beta-blockers after denying me Cogentin even though it was given to me while I was in the hospital. I like the relief from depression that Ablifiy provides but these beta-blockers seem like a requirement for me to be back on it. I've never met anybody on propranolol or metoprolol. Let me know what you know.

Benzos usually don't help Akathisia at all, so I don't recommend them.

I also experienced horrible Akathisia when I went on Abilify the first time. I was put on 40mg of Nadolol (a Beta-Blocker) to try and counter it (my pdoc preferred it to Cogentin). I didn't have any luck & ended up going off the Abilify - even thou it provided some help.

Ultimately, I ran out of choices and decided to try Abilify again. This time I had the Nadolol from the onset and used it at the first sign of the inner anxiety that comes with Akathisia. I also titrated (increased the amount of medication) very slowly.. like two months slowly. I started at 2.5mg (half of the 5mg pill) too. This time has gone really well. I got up to 20mg without any real issues, and am now at 30mg. I went a little too quickly with that increase, so I'm experiencing some slight Akathisia, but the Nadolol gets rid of it completely. The Akathisia is also getting better & I expect it to go away entirely soon.

I believe that the reason the Nadolol didn't work in the first case was because the Akathisia was already so bad that nothing could touch it.. at least anytime soon. It probably wasn't a fair trial of the Nadolol to be honest. Also, since you experienced the Akathisia previously, you'll more than likely have that same response when you go on it again - so I would say that it pretty much is a requirement.. unless you get really lucky with the longer titration. I wouldn't risk it personally.

As for what it's like being on a Beta-Blocker, it's not a big deal for me. I actually take it not only for Akathisia, but also for regular anxiety. I pair it with my Xanax and it works wonderfully. I feel really calm and very stable on it rather than on edge all the time. The only real downside I get from it is that I have to watch my blood pressure. Beta-Blockers will lower your BP whenever you take them. In my case, it lowers it 10pts. This is usually ok for me, but if my BP is already a bit low it'll make me dizzy. Ultimately, if your BP gets *very* low, there's the possibility that you'll pass-out, but you'd have to really overdo it to get that bad.

This is really easy to fix however.. Just eat around and nickel size of salt. Yep, just plain old salt. It'll up your BP back to where it needs to be & you'll no longer be dizzy. ;)

Ultimately, I'd talk to your pdoc about using a Beta-Blocker to counteract the side-effects of the Abilify. If she's against Cogintin she should be for something..

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I have already spoken to my psychiatrist about the use of Cogentin to combat akathisia, but her opinion and that of Wikipedia don't agree. She has told me on two different occasions that Cogentin won't work for akathisia.

Actually the Wiki says:

The first-line treatment of akathisia is usually a beta-blocker, such as propranolol or metoprolol. Benzodiazepines such as clonazepam are also effective. The antihistamine cyproheptadine is also effective, though with shorter effect than beta blockers. Benztropine and Trihexyphenidyl can also be used to treat this condition.

That is what my psycopharmocologist says, Cogentin is not the first choice med, betablockers are. He also makes the point that anticholinergics suck, which I have to agree with having been on a few. I have had a few of these:

Possible effects of anticholinergics include:

* Ataxia; loss of coordination

* Decreased mucus production in the nose and throat; consequent dry, sore throat

* Xerostomia or dry-mouth with possible acceleration of dental caries

* Cessation of perspiration; consequent decreased epidermal thermal dissipation leading to warm, blotchy, or red skin

* Increased body temperature

* Pupil dilation (mydriasis); consequent sensitivity to bright light (photophobia)

* Loss of accommodation (loss of focusing ability, blurred vision — cycloplegia)

* Double-vision (diplopia)

* Increased heart rate (tachycardia)

* Tendency to be easily startled

* Urinary retention

* Diminished bowel movement, sometimes ileus - (decreases motility via the vagus nerve)

* Increased intraocular pressure; dangerous for people with narrow-angle glaucoma

* Shaking

Possible effects in the central nervous system resemble those associated with delirium, and may include:

* Confusion

* Disorientation

* Agitation

* Euphoria or dysphoria

* Respiratory depression

* Memory problems[1]

* Inability to concentrate

* Wandering thoughts; inability to sustain a train of thought

* Incoherent speech

* Wakeful myoclonic jerking

* Unusual sensitivity to sudden sounds

* Illogical thinking

* Photophobia

* Visual disturbances

o Periodic flashes of light

o Periodic changes in visual field

o Visual snow

o Restricted or "tunnel vision"

* Visual, auditory, or other sensory hallucinations[1]

o Warping or waving of surfaces and edges

o Textured surfaces

o "Dancing" lines; "spiders", insects; form constants

o Lifelike objects indistinguishable from reality

o Hallucinated presence of people not actually there

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