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Akathisia from Abilify, Rexulti or any other AAPs experiences


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How can those of you who have been on Rexulti or Abilify the experience of akathisia? I think I am experiencing it as I cannot sit down not even for a minute without getting up and going to the other side of the room to get a cup and then walk around my house, as it almost feels uncomfortable to sit still unless I take my as prescribed xanax dose and valium together. Ambien helps with the restlessness at night obviously because it works well for my insomnia. 

If you've been on other atypical anti-psychotics I would love to hear about if you have experienced or are having akathisia and please tell me more about how this symptom makes you feel and how it affects your lives. Because I feel like it is affecting my ability to do anything for a sustained period of time. Should also mention that I didn't have my ADHD medication for the last 2 weeks so might have been a small factor in the equation.

Anyhow

1 any experiences with akathisia 
2 how did you deal with it or treat it
3 how long did it last for? did it stop when you discontinued the drug? etcetera.
4 how you would best describe it and how it felt for you, what it made you feel like you had to do or that you did or do?
5 what medication and what dosages were you on? Had you recently changed medications or dosages? etcetera

Thanks everyone!!! Can't wait to see the post and read other's experiences as well as sharing mine!

 

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1. Yes just with abilify.....but never with any other of the AAP's like Seroquel or zyprexa or invega, etc.

2. I just paced a lot. I didn't add any meds to treat it. 

3. It didn't last long (thankfully) for me. Maybe a month tops? I was lucky and this side effect went away after my body got used to abilify. This was over 10 years ago so I don't remember exactly how long the akathisia lasted, sorry. (I've been on abilify for over ten years)

4. I felt like I constantly had to move around and inner restlessness. I'd pace most of the day with music on. I didn't know what it was at the time. 

5. Abilify. I think I was mostly at 30 mg but not when I first started it. I think I started at 10-15 then worked up to 30 mg within that first month. Then that side effect disappeared. After I got used to abilify.

I had been on geodon but that didn't work for me. I was IP at the time long term and abilify saved me and I got better enough to go home finally. 

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This is pretty treatable, if it is recognized. There are quite a few drugs that will suppress akathisia.  Abilify is difficult in that it has a high rate of EPS generally and around 20 % rate of akathisia. 

Edited by notloki
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17 hours ago, mmaryland said:

1 any experiences with akathisia 

      I had akathisia on Abilify, Geodon, Risperdal, Invega, Perphenazine, and some minor akathisia on Seroquel. The worst is Abilify and the least-worst is Seroquel.

2 how did you deal with it or treat it

      The doctor I saw when I took most of these meds prescribed Propranolol, which didn't do much, if anything, on the dose he gave me. I've also tried Klonopin, Artane, Amantadine and Cogentin. Klonopin definitely helps, and Amantadine exacerbated all of my symptoms.

3 how long did it last for? did it stop when you discontinued the drug? etcetera.

     
 Usually the akathisia stopped within a couple of days after discontinuation.
  
4 how you would best describe it and how it felt for you, what it made you feel like you had to do or that you did or do?


     
 I felt a horrible, internal restlessness that felt almost like static electricity was present inside my legs and hands. Time also seemed to slow down.

5 what medication and what dosages were you on? Had you recently changed medications or dosages? etcetera

      I can only speak to Seroquel - the minor restlessness I get from it appeared when I was on as little as 300mg.

 

 

Edited by Swamp56
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I lowered my dosage from 2mg to 1.5mg but am currently taking 0.5mg because of the severity of akathisia I was experiencing. I do not like this at all, feeling like I am pacing constantly, like you said @Wonderful.Cheese

My pdoc mentioned propranolol so I might try that or just stop taking the Rexulti if symptoms don't get better and go back to seroquel for treating my mania acutely.

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11 hours ago, mmaryland said:

I lowered my dosage from 2mg to 1.5mg but am currently taking 0.5mg because of the severity of akathisia I was experiencing. I do not like this at all, feeling like I am pacing constantly, like you said @Wonderful.Cheese

My pdoc mentioned propranolol so I might try that or just stop taking the Rexulti if symptoms don't get better and go back to seroquel for treating my mania acutely.

I hope the propranolol works for you! If not I'm glad you have a backup plan with the Seroquel. Good luck!

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Propranolol is very effective, if you can get the dose high enough. If you can it is the drug of choice for akathisia and some other EPS. So a person's blood pressure is the limiting factor. At the lower doses it can affect heart rate more than pressure but if you already have low blood pressure it probably is not the drug for you. For hypertension it is used at 120 to 240 mg, akathisia is more like 20-100 mg daily. 

Edited by notloki
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Hi all, Good news is the akathisia is pretty much gone, I went down to 0.5mg for a day then stopped taking the Rexulti. I am thinking that I experienced the restlessness because I was started on Rexulti at 3mg during a manic phase than down to 2mg, so perhaps the lack of a slow titration and rapid induction of high dosage of a fairly potent -- I say this because the max dose is 4mg in schiz and 3mg in MDD so it must be potent in that it is dosed relatively low -- antipsychotic resulted in my akathisia. I do not want to give up on Rexulti because I do believe it has a lot of potential to help stabilize my rapid cycling manic episodes, as I have not been manic once since starting it. Also another thought, cannaboids are CYP3A4 inhibitors, so maybe marijuana smoking could decrease the elimination of brexpiprazole and cause higher that normal doses to accumulate in my system.

I think I am going to try going back on Rexulti now that the restlessness has subsided and use the sample starter pack to titrate up over 2 weeks from 0.5mg to 1mg, and if it returns then I will have to decide whether or not I want to take an additional medication to treat the akathisia, or giving up on the Rexulti and move onto a different treatment for my bipolar mania. This sucks though, because I liked that Rexulti didn't come with the usual side effects of an AAP like extreme sedation, somnolence, cognitive impairment, etcetera. If anything, I felt Rexulti was helping with my motivation, even when I wasn't taking my ADHD medication, gave me a boost in my mood, relieved my severe insomnia (although I do take Ambien sometimes), and enabling me to get on a much better sleep schedule in addition to waking up easier in the mornings. It was everything I was NOT expecting from an AAP, and I mean this in a positive way. 

On 6/11/2017 at 0:55 PM, notloki said:

Propranolol is very effective, if you can get the dose high enough. If you can it is the drug of choice for akathisia and some other EPS. So a person's blood pressure is the limiting factor. At the lower doses it can affect heart rate more than pressure but if you already have low blood pressure it probably is not the drug for you. For hypertension it is used at 120 to 240 mg, akathisia is more like 20-100 mg daily. 

I am pre-hypertensive, and my ADHD medications increase my heart also, so I don't see propranolol being an issues with respect to that. I was on propranolol before I got prescribed Xanax for social phobia and speaking anxiety but don't remember it being too effective for these two problems (compared to benzos like Xanax at least). I do sweat a lot and given my higher blood pressure maybe the propranolol could help more than the akathisia. 

 

On 6/11/2017 at 3:53 PM, Iceberg said:

Propanolol never worked for me at 80mgs but Ativan 1mg 3 or 4 a day worked 

This is interesting because since Saturday I have increased my Valium and Xanax dosages, perhaps this is why I have been experiencing less akathisia and restlessness. I've been taking about 10mg Valium and 1.5mg-3mg Xanax a day for the past few days during which my restlessness coincidentally subsided. More likely it is a combination of reducing and stopping Rexulti and the benzos that are causing the EPS of akathisia to reduce significantly. I also just read in a psychopharmacology textbook that Klonopin and Ativan are useful for this particular side effect, which is something I might mention my next pdoc visit. Perhaps, if the akathisia persists when I restart Rexulti, I could ask about switching the Valium out for Klonopin or something. Appreciate everyone's input, experiences, and advice, I will keep all this in mind and also keep all of you updated as I attempt to restart the Rexulti. Wish me luck!!

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Also just found this directly from the Rexulti website, confirming that higher doses are more likely to cause akathisia and restlessness. OH and I forgot to mention I have gained 8 pounds :o since being on Rexulti but I am very welcoming of the weight gain since I've struggled to maintain my weight since the beginning of my adolescence. 

  • The most common adverse reactions that occurred at ≥5% and at least twice the rate of placebo were akathisia and weight increased1
  • The incidences of akathisia and restlessness increased with increases in dose1
    • Incidence of akathisia was 4%, 7%, and 14% for the 1-mg, 2-mg, and 3-mg doses, respectively, and 2% for placebo
    • Incidence of restlessness was 2%, 3%, and 4% for the 1-mg, 2-mg, and 3-mg doses, respectively, and 0% for placebo

https://rexultihcp.com/mdd/safety

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Abilify caused slight akathisia, Rexulti does not, although my doses were 2mg and 1mg respectively. I tried 1.5mg Rexulti for a couple of weeks and noticed an uptick in restlessness, so I wouldn't be surprised if 3mg was causing you problems.

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Since being off the Rexulti I definitely have had a return of my manic symptoms, and last night I got no sleep at all. Messaged the pdoc to see if I should resume high dose Rexulti and use propranolol now if it gives me akathisia, or use something temporarily, like seroquel, to get me some sleep and ward off mania until I can titrate up on the Rexulti. I am just nervous because I want more than anything to not end up in a manic episode i just want sleep!!! :wall:

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On 6/10/2017 at 1:12 AM, mmaryland said:

1 any experiences with akathisia 
2 how did you deal with it or treat it
3 how long did it last for? did it stop when you discontinued the drug? etcetera.
4 how you would best describe it and how it felt for you, what it made you feel like you had to do or that you did or do?
5 what medication and what dosages were you on? Had you recently changed medications or dosages? etcetera

 

1. Very sensitive to akathisia and experienced it on most of the APs that I took.

2. I didn't treat my akathisia with anticholinergics or benzodiazepines like is common for many pdocs to do. Mine switched me through the AAPs until we found loxapine which works well for me as well as many of his other patients. At doses 50mg and below it's much more tolerable.

3. It lasted as long as I took it. Akathisia wasn't something that ever went away for me. It would only become slightly less intense or slightly less noticeable. I'm not sure which. Reducing the dose helped but like I said, it never really went away.

4. It felt like two things. A hot butterfly feeling in the pit of my stomach like a ball of energy was just dragging me around as I walked all over the place. I couldn't sit still at my desk at work so I would get up and walk around and go out for a lot of smoke breaks. Got in trouble once or twice for being up from my desk too much. That was an awkward conversation to have to have with your boss.

EDIT: Realized I never put the second thing for #4. Restless legs.

5. Experienced it on Latuda mostly at 60mg and 80mg. It was more tolerable at 40mg. Experienced it as well on Saphris at 5mg. Wasn't as bad at 2.5mg. I also took Abilify and Fanapt but wasn't on either one of those long enough to really gauge it well. I didn't feel akathisia on Zyprexa and I do not currently feel it on loxapine except early in the morning for like an hour or two after I get up.

25 minutes ago, mmaryland said:

Since being off the Rexulti I definitely have had a return of my manic symptoms, and last night I got no sleep at all. Messaged the pdoc to see if I should resume high dose Rexulti and use propranolol now if it gives me akathisia, or use something temporarily, like seroquel, to get me some sleep and ward off mania until I can titrate up on the Rexulti. I am just nervous because I want more than anything to not end up in a manic episode i just want sleep!!! :wall:

I see in your signature that you're taking Rexulti PM. Try taking it AM to see if that helps. Rexulti is a dopamine partial agonist which may put it more on the stimulating side.

Edited by browri
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@browri Sorry to hear that you get akathisia from most AAP. I dont know if I want to continue trying antipsychotics until finding one that works without causing akathisia and helps my symptoms like you did, or taking Rexulti despite the akathisia and just using another medication to treat the restlessness. I am super happy to read that for you it also went away once you discontinued the med; very relieving to hear that it's not something that persists after stopping the drug. 

Your descriptions of akathisia sounds a lot like mine, except the energy isn't a fun or good one. It is more energy making me feel like i must get up to alleviate it, and like you I was getting up and just pacing/walking in attempt to release this weird energy vibe. I have not tried any of the AAP you mentioned, only seroquel and this did not give me akathisia but did give me other side effects.

9 minutes ago, browri said:

I see in your signature that you're taking Rexulti PM. Try taking it AM to see if that helps. Rexulti is a dopamine partial agonist which may put it more on the stimulating side.

I could consider it, but even when I was taking the 3mg and then the 2mg in the evening, I was sleeping better than before I went on the med. It definitely doesn't give me any noticeable sedation and I can't really tell if it is giving me any type of stimulation either. Man I wish there some sort of algorithm to get med cocktails perfectly without the trial and error process :wtf:

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  • 1 month later...
On 6/10/2017 at 1:12 AM, mmaryland said:

How can those of you who have been on Rexulti or Abilify the experience of akathisia? I think I am experiencing it as I cannot sit down not even for a minute without getting up and going to the other side of the room to get a cup and then walk around my house, as it almost feels uncomfortable to sit still unless I take my as prescribed xanax dose and valium together. Ambien helps with the restlessness at night obviously because it works well for my insomnia. 

If you've been on other atypical anti-psychotics I would love to hear about if you have experienced or are having akathisia and please tell me more about how this symptom makes you feel and how it affects your lives. Because I feel like it is affecting my ability to do anything for a sustained period of time. Should also mention that I didn't have my ADHD medication for the last 2 weeks so might have been a small factor in the equation.

Anyhow

1 any experiences with akathisia 
2 how did you deal with it or treat it
3 how long did it last for? did it stop when you discontinued the drug? etcetera.
4 how you would best describe it and how it felt for you, what it made you feel like you had to do or that you did or do?
5 what medication and what dosages were you on? Had you recently changed medications or dosages? etcetera

Thanks everyone!!! Can't wait to see the post and read other's experiences as well as sharing mine!

 

The Xanax helps my need to keep moving/anxiety, though I still have it to some degree. It HAS seemed to have subsided a little bit with time. I have only been on it about a week and a half so can't say for sure if it gets much better. It is definitely already helping my depression. Though I do have some dizziness and lack of coordination. The lack of coordination is very strange, since I have never experienced that before on any meds. I am on .5 mg. I take melatonin at night to help me sleep and that works wonders. Especially because I don't like taking sleep meds, since they make me feel so groggy in the morning.

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