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The Challenges of Restlessness and Appropriate Medications

Restlessness, also known as akathisia, can be a distressing condition characterized by an intense urge to move. Sufferers often describe feeling internal squirming or the inability to sit still. Restlessness can interfere with daily activities and lead to significant frustration. While the exact causes are unclear, restlessness has been associated with certain mental health conditions, movement disorders, and as a side effect of some medications.

When restlessness becomes problematic, medication may help provide relief. However, finding the right medication requires careful consideration of the underlying cause and potential risks. This article explores medications that may be used to treat restlessness along with their benefits and potential side effects.

Antipsychotics for Restlessness With Psychiatric Disorders

For individuals with psychiatric conditions like schizophrenia or bipolar disorder, restlessness is often tied to their mental health symptoms. In these cases, doctors may prescribe antipsychotic medications which work by blocking dopamine receptors in the brain. Dopamine is a neurotransmitter associated with psychosis in conditions like schizophrenia. By reducing dopamine activity, antipsychotics can treat hallucinations, delusions, and thought disorders. At the same time, they may reduce restlessness and agitation.

First generation antipsychotics, such the prescription medications haloperidol (Haldol) or chlorpromazine (Thorazine), are considered effective for treating restlessness related to psychiatric illness. However, they also have a high incidence of extrapyramidal side effects like involuntary muscle movements or tremors. Newer, second generation antipsychotics like olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), or aripiprazole (Abilify) have a lower risk of these types of side effects while still providing antipsychotic action.

Benzodiazepines for Restlessness With Anxiety Disorders

Restlessness and agitation are also common symptoms for individuals dealing with anxiety disorders. In these cases, benzodiazepines like clonazepam (Klonopin) or lorazepam (Ativan) may be prescribed to promote calmness and relaxation. Benzodiazepines work by enhancing the effects of the neurotransmitter GABA in the brain. This can reduce anxiety levels and nervous system activation.

While benzodiazepines offer rapid relief, they also carry risks of sedation, confusion, balance problems, and dependence. To limit issues with addiction and abuse, they are usually prescribed for short term or intermittent use. Individuals taking benzodiazepines should also avoid alcohol and be aware the medications can impair coordination and judgement.

Medications for Restlessness From Akathisia

Akathisia refers to a specific movement disorder characterized by intense restlessness, agitation, and inability to stay still. It may develop as a result of starting or increasing the dosage of certain medications like antipsychotics, antidepressants, or anti-nausea drugs. Akathisia is also sometimes seen as a side effect of things like drug withdrawal. When restlessness stems from akathisia, medications can help block the effects causing excess dopamine activity.

Propranolol (Inderal) is a beta blocker sometimes used to manage akathisia. By blocking epinephrine and norepinephrine receptors, it can calm motor activity. Other options include medications that block cholinergic activity like diphenhydramine (Benadryl) or benztropine (Cogentin). These help balance dopamine and acetylcholine to smooth out motor functioning. In severe cases, substituting a different antipsychotic or antidepressant medication may be warranted if it is believed to be causing akathisia.

Restlessness can stem from many sources ranging from anxiety to medication side effects. Appropriate treatment often starts with identifying potential contributing factors. Medications like antipsychotics, benzodiazepines, and beta blockers may provide relief in some cases. However, medications also carry risks of additional side effects. Working closely with a healthcare provider can help determine the safest options for each individual based on their medical history and the root causes of restlessness. With careful monitoring and the right medications if warranted, restless symptoms can often be well-managed.