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I'm starting to experience akathisia from my latest medication change: moving from Seroquel to Perphenazine. It appears as though I have a predisposition to this side effect, and the following meds have caused it to appear also:

  • Risperal
  • Invega
  • Geodon
  • Abilify

My question is what antipsychotic meds (typicals included) out there have a low risk of akathisia that aren't the ones stated above and also aren't Clozapine and Zyprexa? I've had a hard time finding an easily interpretable comparison sheet! D:

I did read that Fanapt has a relatively low risk, but its efficacy came into question when I spoke with my pdoc about it.

Thanks for any responses!

Edited by Swamp56
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17 hours ago, Swamp56 said:

I'm starting to experience akathisia from my latest medication change: moving from Seroquel to Perphenazine. It appears as though I have a predisposition to this side effect, and the following meds have caused it to appear also:

  • Risperal
  • Invega
  • Geodon
  • Abilify

My question is what antipsychotic meds (typicals included) out there have a low risk of akathisia that aren't the ones stated above and also aren't Clozapine and Zyprexa? I've had a hard time finding an easily interpretable comparison sheet! D:

I did read that Fanapt has a relatively low risk, but its efficacy came into question when I spoke with my pdoc about it.

Thanks for any responses!

I have also heard that Fanapt causes less EPS than other atypicals but it also has a much higher rate of cardiac side effects. I took it for maybe a week and couldn't tolerate it anymore. My heart was POUNDING. Not racing but POUNDING. It was very uncomfortable. I would take it before bed and it would make me so sedated, which was good except I could hear my heart beat in my ears while I was trying to fall asleep.

I am also very susceptible to akathisia and experienced it on Latuda and Saphris. Zyprexa was the first one I took where I could actually sit still but I started blowing up like the Michelin man and my lipids/cholesterol went through the roof. I switched to loxapine 25mg all at bedtime and I've lost all the weight and have no akathisia. Some occasional tics but nothing bothersome. If I increase my dose I will usually feel a LITTLE akathisia for 2-3 days following the dose increase and I only feel it in the morning for an hour or two after I wake up then it goes away and ultimately goes away altogether once my body adjusts to the dose.

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5 hours ago, browri said:

I switched to loxapine 25mg all at bedtime and I've lost all the weight and have no akathisia.

Thanks for your input! What's funny is that my pdoc and I were down to trying Perphenazine or Loxapine, and he thought that Perphenazine had less akathisia risk than Loxapine but a higher risk of other EPS. I'm going to bring Loxapine up with him tomorrow as well.

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11 hours ago, Swamp56 said:

Thanks for your input! What's funny is that my pdoc and I were down to trying Perphenazine or Loxapine, and he thought that Perphenazine had less akathisia risk than Loxapine but a higher risk of other EPS. I'm going to bring Loxapine up with him tomorrow as well.

It's very likely that loxapine does have a higher risk of EPS, but that's at the higher doses. Loxapine used to be dosed like 50-100mg two to three times a day. However, nowadays it's being dosed at 50mg/day or less. At these lower doses it's more of an atypical and carries the same level of EPS risk as any other atypical. In fact I would compare loxapine's EPS to Zyprexa in that for me it only causes some minor tics from time to time but like I said it rarely causes akathisia for me and that's only after dose increases.

I would highly recommend the loxapine. That being said, I have heard some people who have a lot of success with an antidepressant and perphenazine. I think the combo that comes to mine was perphenazine+amitriptyline.

Also I see in your signature that you're currently taking Seroquel. If you've gained any weight on it, you will likely find that you start to lose weight on loxapine. I've lost all the weight that I gained in my trials of all the other antipsychotics that I took and then some. Take it with a grain of salt of course because I do take Vyvanse. But I noticed weight loss with loxapine before I even started Vyvanse. And mind you I was coming on loxapine after Zyprexa which caused me to gain MONDO weight in just 3 months.

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If you are prone to akathisia, you probably have problems finding an antipsychotic that doesn't cause it to some degree. If you have to be on an antipsychotic, you might be better off accepting the side effect and using other meds to treat the akathisia.

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6 minutes ago, jt07 said:

If you are prone to akathisia, you probably have problems finding an antipsychotic that doesn't cause it to some degree. If you have to be on an antipsychotic, you might be better off accepting the side effect and using other meds to treat the akathisia.

My pdoc would definitely disagree. If I had akathisia on an antipsychotic we would try reducing the dose but if it didn't completely go away it was time to move onto an antipsychotic. He isn't one to treat it with anticholinergics like Cogentin because even with those the akathisia can still turn into tardive dyskinesia. I actually ended up being taken off 2.5mg of Saphris which did wonders but the akathisia was still there low grade and didn't go away as I adjusted to the lower dose. Latuda was the same way. Reducing the dose didn't really ultimately make it completely go away. You just have to stick to the APs that are less likely to cause movement disorders like Zyprexa, Seroquel, or Clozaril.

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1 hour ago, browri said:

My pdoc would definitely disagree. If I had akathisia on an antipsychotic we would try reducing the dose but if it didn't completely go away it was time to move onto an antipsychotic. He isn't one to treat it with anticholinergics like Cogentin because even with those the akathisia can still turn into tardive dyskinesia. I actually ended up being taken off 2.5mg of Saphris which did wonders but the akathisia was still there low grade and didn't go away as I adjusted to the lower dose. Latuda was the same way. Reducing the dose didn't really ultimately make it completely go away. You just have to stick to the APs that are less likely to cause movement disorders like Zyprexa, Seroquel, or Clozaril.

It depends on the diagnosis and how susceptible you are to akathisia. You are BP II. The OP is SZA. There is a limit as to how much he can reduce his dose and he needs an AP. Moreover, if most APs give the OP akathisia, it means he is very susceptible to akathisia and since he needs an AP the only option is to treat the akathisia. Clozaril is an antipsychotic of last resort and comes with some pretty heavy potential side effects.

Akathisia is treatable.

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14 minutes ago, jt07 said:

It depends on the diagnosis and how susceptible you are to akathisia. You are BP II. The OP is SZA. There is a limit as to how much he can reduce his dose and he needs an AP. Moreover, if most APs give the OP akathisia, it means he is very susceptible to akathisia and since he needs an AP the only option is to treat the akathisia. Clozaril is an antipsychotic of last resort and comes with some pretty heavy potential side effects.

Akathisia is treatable.

Very true. Sometimes there really isn't any way around using an AP. I recognize that. I think my doctor feels that in my case the risks outweigh the benefits. But he has told me that he feels that I should always be on an antipsychotic because his notes and records show that I'm the most stable when I'm taking one. And they also show that I've been the least depressed when I'm on an antidepressant.

I still stick by my loxapine suggestion though. I find it to be a wonder drug and they'll have to pry it from my cold hard hands.

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4 hours ago, browri said:

Very true. Sometimes there really isn't any way around using an AP.

Yeah, I don't really have a choice in the matter due to the schizophrenia portion of my illness :( .

25 minutes ago, Iceberg said:

Also can use low dose benzos to help the akathisia 

I've been doing this as well... I've been taking my PRN on a schedule, though a higher dose is probably warranted.

6 hours ago, jt07 said:

If you have to be on an antipsychotic, you might be better off accepting the side effect and using other meds to treat the akathisia.

The problem is that I've tried several meds for it and they didn't help much. I am willing to accept some level of akathisia once I've exhausted my options on meds with traditionally low rates of akathisia. But yeah, I don't have may options left.

I did see my pdoc today and  we're going to try Fanapt next. Its spec sheet showed that it actually had a lower incidence of akathisia than a placebo (albeit not by much). I got the Fanapt "starter pack" and about 2-3 weeks of medication from his stash (he has TONS of samples lol).

Edited by Swamp56
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13 hours ago, Iceberg said:

Good luck,... Never heard any stories really 

@Swamp56 I took it for about 10 days. Not long enough to tell how effective it would be for my intrusive thoughts though because of the cardiac side effects. It caused my heart to pound so I had to quit it, but I would be immensely curious to hear a success story. I do seem to recall not having any akathisia for the short time that I was taking it.

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  • 1 month later...
On 6/6/2017 at 9:15 PM, Swamp56 said:

I'm starting to experience akathisia from my latest medication change: moving from Seroquel to Perphenazine. It appears as though I have a predisposition to this side effect, and the following meds have caused it to appear also:

  • Risperal
  • Invega
  • Geodon
  • Abilify

My question is what antipsychotic meds (typicals included) out there have a low risk of akathisia that aren't the ones stated above and also aren't Clozapine and Zyprexa? I've had a hard time finding an easily interpretable comparison sheet! D:

I did read that Fanapt has a relatively low risk, but its efficacy came into question when I spoke with my pdoc about it.

Thanks for any responses!

I have had bad experiences on Abilify and Risperdal. Rexulti so far is great for my depression and the side effects are manageable. The need to move around and stay busy with very intense in the beginning, but seems to be subsiding a bit, and my Xanax helps with that. I take melatonin at night to help me calm down and sleep.

Regarding Fanapt, I have a friend who takes it and it does wonders for her.

Edited by Cleo Cat
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