Living with a deep, internal restlessness is a terrifying experience, especially when you don’t have the right words for it. It can feel like your body is screaming for an escape you can’t find, a desperate urge to crawl out of your own skin.
You may have been told it’s “just anxiety,” but trying to calm a mind that isn’t the source of the problem feels like a losing battle. This guide will provide the clarity you need to tell the difference—not just to find a label, but to find the right words to advocate for yourself and start the journey back to feeling at home in your body.
Jump to a section
- The main difference between akathisia and anxiety
- A self-assessment checklist: is it akathisia or anxiety?
- Comparing the symptoms
- Common causes of akathisia
- How to get a correct diagnosis
- How to talk to your doctor about restlessness
- Treatment and management for akathisia
- Coping with the distress of akathisia right now
- A guide for family and friends
- How akathisia is different from other conditions
- What to do if your doctor thinks it’s just anxiety
- The link between akathisia and suicidal thoughts
Key takeaways
- Akathisia is a physical urge: It is a medication-induced movement disorder causing an uncontrollable, physical need to move.
- Anxiety is a mental distress: Its restlessness stems from worry or fear, and movement is usually voluntary.
- The key test is control: With anxiety, you can often choose to be still; with akathisia, it feels nearly impossible.
- Medication is the primary cause: Akathisia is most often a side effect of antipsychotics and some antidepressants.
- This is a medical urgency: Due to its severe distress, akathisia requires prompt medical evaluation and should not be dismissed.
The main difference between akathisia and anxiety
To find the right path forward, it helps to understand where the feeling of restlessness begins.
Akathisia: an uncontrollable physical urge to move
Akathisia is not a feeling of worry that causes restlessness; it is a physical, neurological event that creates the distress. It’s an uncontrollable physical urge to move that originates deep within the body, like an engine stuck in high gear.
This relentless command to move is what generates the profound sense of inner torment. Your mind is simply reacting to the inescapable physical sensation, trying to make sense of a body that will not —and cannot —be calm.
Anxiety: a mental distress with physical symptoms
Anxiety, in contrast, begins in the mind. It is a state of excessive fear, worry, or distress that then sends signals to the body. The restlessness you feel with anxiety—like pacing before a big presentation or fidgeting during a difficult conversation—is your body’s response to your thoughts.
While the physical feelings are real and uncomfortable, they are a consequence of the mental state. Your body is following your mind’s lead.
The key distinction: can you choose to be still?
This brings us to the most important question you can ask yourself. When the urge to move strikes, do you have a choice?
With anxiety, even when it’s severe, there is often a small window of control. You might feel an intense urge to pace, but for a few moments, you can likely force yourself to sit still. With akathisia, that choice is virtually gone. The drive to move is so overwhelming that remaining still feels nearly impossible, and trying to fight it only makes the inner torment worse.
A self-assessment checklist: is it akathisia or anxiety?
This is not a diagnostic tool, but a private guide to help you find the language for what you are experiencing. Answering these questions honestly can help you organize your thoughts before speaking with a doctor.
Questions about your thoughts
The distress from both conditions can be overwhelming, but it often speaks a different internal language.
- Is the engine of your distress a looping track of specific worries, fears, or “what-if” thoughts? (More common in anxiety)
- Or is the primary feeling a sense of inexplicable terror or dread that seems to come from nowhere, which your mind then tries to explain? (More common in akathisia)
- When you are physically still, does your mind still feel like it’s racing with anxious thoughts? (More common in anxiety)
Questions about your physical feelings
This is about pinpointing where the distress seems to originate—your mind or your body.
- Does the urge to move feel like a deep, physical command that you cannot ignore, as if your muscles themselves are demanding action? (More common in akathisia)
- Or does the restlessness feel more like a side effect of your mental state—a buzzing energy that comes from being worried or afraid? (More common in anxiety)
- Are your physical symptoms, like a fast heartbeat or sweating, directly tied to moments of intense worry? (More common in anxiety)
Questions about your ability to control movement
This final set of questions gets to the heart of the matter we explored in the last section.
- If you absolutely had to for one full minute, could you force your body to be completely still, even if it felt awful? (Often possible with anxiety)
- Does the thought of being forced to stay still—for example, on a long flight or in a movie theater—fill you with a unique sense of panic or horror? (A key indicator of akathisia)
- Does moving your body, like pacing or rocking, provide a small moment of relief from an unbearable physical sensation? (A hallmark of akathisia)
If your answers point toward an uncontrollable physical urge that feels separate from your thoughts, it is essential to bring this up with your doctor. Trust your sense that something is wrong.
Comparing the symptoms
While the checklists help organize your experience, putting a name to the specific feelings can be the most validating step. Here is a closer look at how akathisia and anxiety show up in your inner and outer world.
What akathisia feels like
This is the part of the experience that others cannot see, and often the hardest to describe.
The inner feeling of terror or dread
This isn’t the worry you feel before a deadline; it’s a raw sense of torment that has no clear cause. People who experience it often describe a feeling of wanting to jump out of their own skin or a profound sense that something is terribly and fundamentally wrong.
What appears to be agitation on the outside is often a desperate attempt to escape an unbearable feeling on the inside.
The overwhelming need to move your body
This is the hallmark of akathisia. It’s a non-negotiable, biological command to move that feels separate from your own will.
It’s the sensation of having an internal motor you can’t turn off, where the only thing that offers a split second of relief is giving in to the movement.
What akathisia looks like to others
To an observer, akathisia can be mistaken for simple restlessness or agitation, but the movements have a distinct, driven quality.
Pacing, rocking, or shifting weight
This is often the most visible sign. It’s not a casual stroll but a relentless, repetitive pacing. It can also look like an inability to stand still, with a constant shifting of weight from one foot to the other, or a rhythmic rocking motion while sitting or standing.
Fidgeting or crossing and uncrossing legs
While seated, a person with akathisia may seem unable to find a comfortable position. This can appear as a constant, almost frantic crossing and uncrossing of the legs, tapping of the feet, or shuffling in their chair. These are not nervous habits; they are compelled actions to soothe a relentless internal state.
Common symptoms of anxiety
Anxiety can also create a powerful urge to move, but its signature is different because the feeling is a reaction to a thought.
Worrying thoughts and feelings of fear
The engine of anxiety is a mind focused on threat. It often shows up as a loop of worry about what might go wrong. The dread you feel is usually tied to a specific “what if” thought.
Physical signs like a fast heartbeat or sweating
The physical restlessness of anxiety is the body’s alarm system responding to those thoughts. It can look like fidgeting or pacing, but it is often accompanied by other classic signs of a stress response, such as a racing heart, sweating, trembling, or shortness of breath. The key difference remains: these symptoms rise and fall with the intensity of your worry.
Common causes of akathisia
This isn’t a random event or a personal failing; it’s a predictable, biological response to specific triggers, most often medication. Understanding that this is a side effect—a reaction happening inside your brain—is the first step toward removing self-blame and finding a solution.
The link to medications
Akathisia happens when a substance disrupts the delicate balance of dopamine, a key chemical messenger that helps regulate movement. Think of it as a constant, unintended signal being sent to your body to “go” when it should be at rest.
Antipsychotic medications
These are the most common causes. Both older and newer antipsychotics can trigger akathisia, especially when a dose is started or increased. They work by blocking dopamine receptors, which is a necessary for their therapeutic effect, but this action can inadvertently cause the intense physical restlessness you feel.
Antidepressants
While less frequent, some common antidepressants, particularly Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), can also cause akathisia. The mechanism is complex but is also thought to involve changes in the brain’s dopamine signaling pathways.
Other common drugs
A range of other medications have been linked to akathisia, including some used for nausea, mood disorders, or even stimulants. This is why providing your doctor with a complete list of everything you take—including over-the-counter drugs and supplements—is so vital.
Can stress or anxiety cause akathisia?
This is a critical point of confusion, so let’s be clear: stress and anxiety do not cause akathisia. Akathisia is a medication-induced movement disorder with a physical origin in the brain.
However, the terror of akathisia can absolutely cause feelings of anxiety, creating a vicious cycle. Your stress is a valid reaction to an unbearable physical state, not its cause.
How to get a correct diagnosis
Walking into a doctor’s appointment when you feel unheard can be the most intimidating part of this journey. This plan is about making sure your experience is taken seriously.
Preparing for your doctor’s appointment
The single most powerful tool you have is a clear, organized record of your experience. Your goal is to translate your feelings into clinical facts.
Create your symptom and medication log.
- List all medications: Write down every prescription, supplement, and over-the-counter drug. Note the dosage and the date you started each one.
- Build a timeline: Pinpoint the exact date your restlessness began to show a clear “before and after” picture. For example: “Started [Medication Name] on June 1st. Began feeling the intense urge to pace on June 5th.”
- Use specific language: Instead of saying “I feel restless,” use phrases like “I have an uncontrollable urge to move my body,” “I feel like I could crawl out of my skin,” or “It’s impossible for me to sit still.”
What to expect during the evaluation
A thorough evaluation for akathisia involves more than just talking; it involves careful observation. Understanding this can help you feel less self-conscious and more prepared.
Your doctor should ask about your inner feelings of restlessness, but they will also need to see the physical signs. They may ask you to sit or stand still for a period to assess your ability to control your movements. This can feel like a test, but it’s important to be honest.
Do not try to hide your movements
Your instinct might be to “power through” the discomfort to appear calm, but this can lead to a misdiagnosis. Allow the doctor to see the reality of what you’re experiencing. If you need to shift, rock, or stand up, do so, and say, “This is what it feels like—I have to move.”
The Barnes Akathisia Rating Scale (BARS)
To make the diagnosis more objective, your doctor may use a tool specifically designed to measure this experience. It is the gold standard for assessing akathisia and helps distinguish it from general agitation or anxiety. This tool is called the Barnes Akathisia Rating Scale (BARS). The scale has a few key parts:
- Objective signs: The clinician observes your movements, like fidgeting, rocking, pacing, or shifting weight.
- Subjective awareness: You will be asked to describe your inner restlessness. Do you feel an urge to move?
- Subjective distress: You will be asked how much this feeling is bothering you. Is it mildly annoying, or is it causing severe torment?
- Global assessment: The doctor combines these findings to rate the overall severity.
Knowing about this tool is empowering. It gives you a way to advocate for a more structured evaluation. If you feel your experience is being minimized, you can calmly and confidently ask, “I’ve read that the BARS is a helpful tool for this. Would it be possible to use a standardized scale to assess my symptoms?” This signals that you are an informed and active participant in your health.
How to talk to your doctor about restlessness
You now have the context, the language, and a plan. This final piece is about putting it all into action in the moment. The goal is to start the conversation with a clear, calm, and undeniable description of your experience that immediately separates it from anxiety.
Using clear language to describe your symptoms
When you speak to your doctor, the words you choose matter. Vague terms like “anxious” or “restless” can easily be misinterpreted. The key is to describe the physicality and uncontrollable nature of the urge. Focus on the “what” and “when”:
- Lead with the physical feeling: “I’m experiencing an intense, physical urge to move that I can’t control.”
- Connect it to medication: “This feeling started about a week after I began taking [Medication Name].”
- Describe the impossibility of stillness: “When I try to sit still, the feeling of inner torment gets much worse.”
- Contrast it with anxiety: “This feels very different from my usual anxiety. It’s not in my head; it feels like it’s in my body.”
This approach moves the conversation from a general discussion about mood to a specific investigation of a potential medication side effect.
A sample script to start the conversation
Walking in with a prepared opening statement can help you feel grounded and in control. You don’t need to memorize it, but having the core points ready can make all the difference.
Here is a simple, powerful way to begin:
“Doctor, I need your help with a very distressing physical symptom I’ve been having. Since I started [Medication Name], I’ve developed an uncontrollable urge to move. It’s not just a feeling of being fidgety—it’s a constant, physical need to pace or shift my body that feels impossible to ignore. It’s causing me a great deal of distress, and it feels very different from the anxiety I’ve experienced before. I’ve kept a log of my symptoms and medications to show you.”
What to do if you feel dismissed
It is a difficult reality that even with perfect preparation, you may feel your concerns are being minimized. Take a deep breath. You are in control of this conversation.
If your doctor immediately says, “It’s just your anxiety,” do not argue. Instead, calmly redirect the conversation back to the evidence you brought.
You can say:
“I understand why it might look like anxiety, but the timeline in my log shows this started right after the medication change. Could we explore the possibility of it being a side effect, just to be safe?”
This response is not confrontational. It validates the doctor’s perspective while firmly re-centering your own. It transforms the conversation from a debate about feelings into a collaborative process of elimination. This is the heart of effective self-advocacy.
Treatment and management for akathisia
Getting the right diagnosis is the first victory. The next step is finding relief. The primary goal of treatment is simple: to turn down the volume on that relentless internal motor so you can feel at peace in your own body again. This journey almost always begins by addressing the medication that caused the problem.
Changing or stopping the medication
The most direct and effective approach is to adjust the medication that is causing the akathisia. This is the first-line strategy and should always be the primary focus of your conversation with your doctor.
It’s completely normal to feel scared by this idea. You might be thinking, “But this medication is the only thing that has helped me feel stable.” That fear is valid. This is not a choice between your physical comfort and your mental health. It is a collaborative process of finding a new balance that allows you to have both.
This process, guided by your doctor, can involve:
- Reducing the dose: Often, a small reduction in dose can eliminate akathisia while preserving the medication’s benefits.
- Switching to a different drug: Your doctor can transition you to an alternative medication known to have a much lower risk of causing this side effect.
- Stopping the medication: If appropriate for your overall treatment, the medication may be slowly and safely tapered off.
Medications that can help reduce symptoms
If adjusting the primary medication isn’t possible or doesn’t provide enough relief, your doctor has other tools. They may prescribe a second medication specifically to counteract the akathisia and provide immediate relief from the distress. Think of these as targeted rescue medications:
- Beta-blockers (like propranolol): Often the first choice, these medications work by calming the physical “fight-or-flight” signals that fuel the restlessness, often without causing drowsiness.
- Benzodiazepines (like lorazepam): These can be very effective for providing rapid, short-term relief from the severe inner torment and panic that akathisia causes. Due to the risk of dependence, they are typically used as a temporary bridge.
- Serotonin antagonists (like mirtazapine): Certain antidepressants at specific doses are highly effective in reducing akathisia symptoms, offering another pathway to relief.
- Vitamin B6: For those seeking options with fewer side effects, Vitamin B6 is a safe and effective approach for managing antipsychotic-induced akathisia.
Does akathisia go away on its own?
This is a critical question with a clear answer. Acute akathisia—the kind that appears shortly after a medication change—often improves or resolves completely once the offending drug is adjusted.
However, you cannot afford to wait and see. If left unaddressed, akathisia can become chronic and much harder to treat. The feeling that you “should just power through it” is a dangerous instinct here. Your immediate advocacy is the most important factor in preventing this unbearable feeling from becoming a long-term reality.
Coping with the distress of akathisia right now
While you and your doctor work on a long-term solution, you need tools to survive the immediate, moment-to-moment torment. These strategies are not a cure, but they are a way to anchor yourself when the internal storm feels overwhelming and profoundly isolating.
Grounding techniques to manage panic
The terror of akathisia can easily trigger panic. Grounding is the act of pulling your focus out of that terrifying internal state and into the physical world. It’s a way to remind your nervous system that you are safe, even when your body feels like it isn’t.
When you feel the panic rising, try this simple 5-4-3-2-1 exercise:
- 5: Notice five things you can see. Look around you and name them, either silently or out loud. A lamp. A crack in the ceiling. The color of your socks.
- 4: Notice four things you can feel. The texture of your jeans. The cool surface of the table. The weight of your feet on the floor.
- 3: Notice three things you can hear. The hum of the refrigerator. A distant siren. The sound of your own breathing.
- 2: Notice two things you can smell. The coffee on your desk. The soap on your hands.
- 1: Notice one thing you can taste. Take a sip of water or simply notice the taste in your mouth.
This isn’t about distracting yourself; it’s about intentionally redirecting your brain’s attention to the solid, real world around you.
The importance of gentle movement
Fighting the urge to move is often a losing battle that only increases your distress. The key is to work with your body, not against it. Instead of trying to force stillness, give the restlessness a safe and gentle outlet.
This is not about intense exercise, which can sometimes make the feeling worse. It’s about finding a rhythm that soothes.
- Pace with purpose: Instead of frantic, aimless pacing, walk slowly and deliberately around a room. Focus on the feeling of your feet making contact with the floor.
- Rock rhythmically: If you are sitting, rock gently in a chair. Try to find a steady, calming rhythm.
- Stretch your limbs: Slowly and intentionally stretch your arms, legs, and back. Focus on the sensation in your muscles.
By giving the energy a job to do, you can sometimes lessen its chaotic power and reclaim a small sense of control.
Finding a moment of connection
Akathisia can make you feel utterly alone, trapped inside an experience that no one else can see or understand. This is when seeking social support becomes a lifeline. You don’t have to explain the complex neurology; you just have to communicate your need.
Reach out to one trusted person—a friend, partner, or family member—and say:
“I’m going through a really difficult physical experience right now, and it’s making me feel scared and alone. Could we just sit together for a little while, or could you talk to me on the phone to help me feel grounded?”
The goal isn’t to find someone who can fix it. It’s to find someone whose calm presence can serve as an external anchor when your internal one is lost.
A guide for family and friends
Watching someone you care about endure akathisia can be frightening and confusing. You can see their distress, but you can’t see the cause. Your role isn’t to fix the problem, but to be a calm, steady presence and a strong advocate. Your support can make an enormous difference.
A guide to handling work, school, and social events
The key to navigating these situations is preparation. Going in with a plan shifts you from a position of defense to one of quiet readiness. It allows you to manage the environment, rather than letting the environment manage you.
How to recognize the signs
Your loved one may not have the words for what’s happening, so your observations are critical. You’re looking for a distinct change in their behavior, often after a medication has been started or adjusted. Look for these key signs:
- A new, relentless restlessness: This is more than just fidgeting. It’s a constant pacing, an inability to sit through a meal or a movie, or a repetitive rocking or shifting of weight that seems compelled.
- Visible distress: They may seem intensely irritable, panicked, or distressed for no apparent reason. Remember, the agitation you see on the outside is a reflection of a tormenting feeling on the inside.
- Verbal cues of inner turmoil: They might use phrases like “I feel like I’m going to explode,” “I want to crawl out of my skin,” or “I can’t get comfortable no matter what I do.”
How to provide support during an appointment
Your presence at a doctor’s appointment is incredibly valuable. You can serve as a second set of ears, a source of moral support, and a clear-headed advocate. Here’s how you can be most effective:
- Be the designated note-taker: Help document the conversation. Write down the doctor’s recommendations, any medication changes, and the follow-up plan. This frees your loved one to focus on describing their experience.
- Corroborate their story: When your loved one describes their symptoms, you can validate their experience from an observer’s perspective. A simple statement like, “Yes, I’ve noticed the pacing started right after the new prescription,” can be very powerful.
- Help ask the hard questions: If your loved one is feeling overwhelmed, you can help ensure their concerns are addressed. You can calmly ask, “We’re concerned this might be akathisia. What are the next steps to rule that out or confirm it?”
Your calm, supportive presence helps ensure that your loved one’s experience is taken seriously and that they leave with a clear plan.
How akathisia is different from other conditions
Part of advocating for yourself is knowing what you don’t have. Akathisia is often confused with other movement disorders because they can look similar from the outside. Understanding these key differences can help you and your doctor narrow down the diagnosis with greater confidence.
Akathisia vs. restless legs syndrome (RLS)
While both involve a powerful urge to move, the timing and location of that urge are different.
- The feeling in RLS is specific: Restless Legs Syndrome (RLS) is primarily a neurological disorder characterized by an uncomfortable, often painful sensation specifically in the legs. People describe it as a creepy-crawly, pulling, or throbbing feeling.
- The feeling in akathisia is global: Akathisia is a generalized sense of inner restlessness that can feel like it’s in your entire body. While your legs may be moving, the torment is a full-body experience, not one isolated to a single area.
- Timing is a key clue: RLS symptoms are famously worse in the evening and at night, especially when lying down to rest. Akathisia can happen at any time of day and is directly linked to medication schedules, not the time of day.
Akathisia vs. tardive dyskinesia
Both of these conditions can be side effects of the same medications, but the movements themselves are fundamentally different.
- Tardive dyskinesia involves involuntary movements: Tardive dyskinesia (TD) causes repetitive, involuntary movements that you cannot control, like blinking, lip-smacking, or grimacing. These are movements your body does to you.
- Akathisia involves a voluntary response to an urge: Akathisia is the urge to move. The movements you make—like pacing or rocking—are semi-voluntary actions you take to try to relieve that unbearable inner feeling. They are movements you do because of the urge.
- Onset is different: Akathisia can appear very quickly, sometimes within days of starting or changing a medication. TD typically develops after long-term use of a medication, often over many months or years.
What to do if your doctor thinks it’s just anxiety
This is perhaps the most difficult and invalidating moment in the entire process. You’ve done your research, you’ve tracked your symptoms, and you’ve courageously described your experience, only to be met with a diagnosis that you instinctively know is wrong. Do not give up. Your clarity and persistence are your greatest assets now.
How to advocate for yourself
When you are dismissed, the instinct is to become frustrated or discouraged. The more effective path is to remain calm and become more methodical. You are not there to win an argument; you are there to collaboratively solve a medical puzzle. If your doctor insists it’s anxiety, use this two-part strategy:
Acknowledge and redirect
Start by acknowledging their perspective, then immediately pivot back to your evidence. This shows you are listening but are not abandoning your position.
“I understand why it might look like anxiety, and I know I do have anxiety. However, the log I brought shows this specific physical feeling started exactly four days after I started the [Medication Name]. Could we look at that timeline together?”
Request a trial
Frame your request not as a demand, but as a diagnostic test. This is a low-risk, high-information way to see if the medication is the true cause.
“I am willing to continue working on my anxiety, but I am deeply concerned the medication is the trigger here. Would you be open to a trial of a small dose reduction for one week to see if the physical urge to move improves? If it doesn’t, I’ll know you’re right. If it does, we’ll have our answer.”
This approach reframes you from a “difficult patient” to a proactive partner in your own care.
When and how to get a second opinion
You have the right to feel confident in your medical care. It is time to seek a second opinion if your doctor is unwilling to consider the medication as a possible cause, you continue to feel dismissed, or your concerns are not being addressed.
Trust your gut. Getting a second opinion is not a sign of disrespect; it is a responsible step in taking care of your health.
Here are the practical steps:
- Ask your insurance provider: Call the number on the back of your insurance card and ask for a list of in-network psychiatrists or neurologists in your area.
- Request your records: Call your current doctor’s office and ask for a copy of your recent medical records, including lab results and visit summaries. You have a legal right to these.
- Prepare your story again: When you meet the new doctor, you don’t need to focus on your negative experience. Simply present your symptom and medication log and say, “I’m here for a second opinion on a distressing physical symptom that began after I started a new medication.”
The link between akathisia and suicidal thoughts
The link between akathisia and suicidal thoughts is a serious concern. The relentless inner torment and physical restlessness can create a sense of desperation and hopelessness. This feeling is not a reflection of your character or your desire to live. It is a potential symptom of the condition itself.
If you are having thoughts of harming yourself, it is a sign that the akathisia has become a medical emergency. These thoughts are a dangerous side effect, not the truth of who you are. Your brain is sending a false signal because it is in an extreme state of distress.
You must reach out for help immediately.
Where to get immediate help
If you are in crisis, your only job right now is to tell someone who can help. Do not wait. Use one of these options right now.
- Call or text 988 in the U.S. and Canada. This will connect you to the Suicide & Crisis Lifeline. It is free, confidential, and available 24/7.
- Go to the nearest emergency room. Tell the staff you are experiencing a severe medication side effect and are having thoughts of harming yourself.
- Call 911 or your local emergency number.
Your life is valuable. The unbearable feeling you have right now is treatable. Please make the call.
Hope for your journey
This guide isn’t about giving you a perfect label for your pain. It’s about giving you the right words and the confidence to trust what your body is telling you. The journey back to feeling calm isn’t about fighting harder; it’s about advocating smarter. Start by writing down one sentence that describes the physical feeling, without judgment. That single sentence is how you begin to speak your truth and be heard.
Care at Modern Recovery Services
The feeling of being trapped in your own body by a relentless restlessness is profoundly isolating. At Modern Recovery Services, you will work with a compassionate clinical team to get a clear diagnosis and find a safe, effective path to relief.