I developed akathisia from intramuscular maxolon! It was absolutely horrendous wouldn't wish it on my worst enemy. It took hours for it to wear off. I thought I was crawling out of my skin.
I am currently experiencing dyskinesia after stopping Abilify. The hope is that it is a symptom of withdrawal and will go away. It has been so upsetting and also painful. I am a psych nurse and this has really opened my eyes to what my patients may be feeling struggling with EPS.
When I was in hospital for my treatment resistant psychosis I tried many different medications that weren’t working, finally got put on a different first generation antipsychotic, started at a decent dose and developed akathisia as well as some mild dystonia. Let me say that akathisia is one of the worst things I have ever experienced. I truly felt like I was dying, I was really thinking I was gonna die in hospital. The literal definition of feeling like you’re crawling out of your skin, but worse somehow.
Newly qualified MH nurse here, thank you for the info, I knew about EPSEs obviously but it's all quite confusing , so will be saving this and coming back to it so I can better look out for these in my patients 😊
It's not just psychiatric medicine that can do this - I had something to treat an inner ear problem which gave me some of these problems so be aware it can be a range of medicines.
I had acute dystonia from taking haloperidol while I was hospitalized and it was almost traumatic, I was literally begging doctors to make it stop. they gave me biperiden im and it didn't work at all so they switched to iv and the relief was indescribable
Love your channel. As a new grad nurse entering into behavioral health I am unable to how appreciative I am for the knowledge I have acquired from your videos.
I have tardive dyskinesia from taking Haldol, followed by respiridone since 1984. I was switched to clozapine but I had bad blood work. I had one psychiatrist who applied for a grant to get a medication covered to help with it. I'm in Canada, and although health care is universal, drug coverage is not. My care was passed to a different psychiatrist when that one retired and the current doctor is not pursuing the grant. His idea is to decrease the respiridone so that the side effects are less. It really is frustrating to have this side effect. I find the hardest thing is the trip to the dentist. The hygienist is never educated about it, and I get tired of explaining it. At least dentist's are taught about it, but if I see a new one, I have to remind them from their training. I can control it, but not for a whole dental thing. It also affects your appearance. As 8f people see you on the bus or whatever, you aren't just sitting still. Your mouth is moving. People associate this with mental illness, which is often invisible. Not so in my case.
I can’t even imagine how awful that would be and never thought about how that would impact seeing the dentist! I’m so sorry you have to go through that! God bless u and i hope you can somehow find some peace!
I was put on 10mg of abilify in the hospital, it was the first time i was taking it. I developed a muscle twitching in the face and akathesia! It was a nightmare! But, i still continued to take it at a lower dose. I am now completely of it now! So happy!
Thanks so much for replying. Im day 3 on 5mg. But needing opiates to counter the akethesia.hoping in a week or so i can go without and cope ok on 5mg without the benzos. Thank you
I was searching for information on these. Working with autistic people, they often take medication that can give them side effects and people don't always know to look out for those. I wanted to see examples because I read a lot on it, but wanted to see what every symptom looks like. As a special educator, it's really valuable to have subscribed to you! Merci beaucoup Dr Syl!
I developed Akathisa from Latuda and it was THE worst feeling I have ever experienced hands down. Every muscle in my body had this extreme unrelenting need to move, but no matter how much I moved, the feeling was never satisfied in the slightest. I had not been warned of the possibility of this side effect by my doctor, which caused a lot of anxiety and panic as I felt like my skin was crawling and I wanted to rip my skin off my body as it was just so horrible. I would not wish this on my worst enemy.
Dr. Syl, you do such a great job of teaching and explaining complex concepts. Your channel might be the most interesting one on youtube. Thank you so much for covering these important concepts as I'm sure it helps sufferers of these conditions feel not so alone and that there is hope for them.
I got Tardive Tourettism from Abilify, I have vocal and motor tics that are somewhat suppressible around people, they go down to minor tics when I socialize and go up when I'm alone to phrases and gestures.
Doctor, I just want you to know how much you're helping do these videos sir. The only suggestion I might add is trying to make videos specifically for children if possible, I got started in mental health at 5 years old maybe not that young but certainly as a preteen and teen your videos wouldve been a boon back then.
I have dealt with akathisia from several antipsychotic medications including the one im currently on. Its very difficult to manage and very distressing. But i have been willing to manage it to have some quality of life when it comes to my mood symptoms.
I developed Akathesia. It was the worst thing that ever happened to me. I also had dyskinesia too. Thankfully it went away otherwise I knew I wasn’t going to be able to live anymore cuz it was so distressing. I told the psychiatrist and he said try a different one, and I said no I’m not doing it again. He didn’t believe me, obviously I didn’t k or what happened at the time but I found out a yr later. Having been a RN I saw so many RN’s push IV Metoclopramide in fast. They didn’t even understand EPS.
Greetings from Canada 🇨🇦 I really appreciate your videos as they are very informative. You kind, personable and gentle delivery makes them enjoyable. I think you’ll be a fabulous Psychiatrist! 😊
I had dystonia from taking metoclopramide. I had intense nausea and I took one pill, then I don't remember why I was taken to the ER, and I don't know why the doctors didn't ask if I had taken anything before injecting me with more metoclopramide. When I got back home my neck and shoulder started twisting against each other involuntarily. Funny thing is, I've taken an array of actual psychiatric medications over the years for depression, anxiety, and OCD, and I've never had extra pyramidal symptoms with antidepressants or antipsychotics.
I got an acute dystonic reaction from Abilify once. It was horrible. It was a severe reaction as well. I felt like it started out with akathisia as well. At least I felt severley restless and didn't know why. Then my neck started twitching more and more. In th end my whole neck and trunk started twisting backwards kind of. It was so distressful. Had to recieve several shots to contradtict the effect of Abilify (I think, I don't really know what I got, but after a few hours, it was all good). I also had a lot of tremors for years. Not like this parkinsonism, just light tremors all the time and sometimes so severe it was hard to eat (like lifting the fork to my mouth). Also had some kind of movement issue in one of my feets. It kind of sounds like tardive dyskinesa, but again, it was my foot and not my face. It was an unconcious movement all the time as long as I was resting. I could force it to stop, but it would start again if I stopped thinking about it. Both of these issues resolved themselves when I quit that particular med, thankfully.
I wish people would remember it's not just anti-psychotics that trigger EPS. I've had short-term akathisia from an anti-nausea med (Maxolon) and an anti-histamine (Phenergen), along with a weird movement thing. I experienced akathisia in hospital right after being given an anti-nausea med (Maxolon). It was the worst feeling I've ever experienced! I suddenly wanted to tear my skin off and escape my body. Every atom in my body wanted to escape. It only lasted an hour or so, but I would've wanted to die if it had gone on any longer. It was excruciating. Like another comment on here said, it is NOT like anxiety. It was literally the middle of the night on the ward, so it was just the night duty nurses who were there. I'm pretty sure they assumed I was just having a random 'panic attack' or something the night before a procedure, and were trying to calm me down. No one at the hospital put it together that I had actually had an adverse reaction to a medication they gave me. I also kept NEEDING to bend my left arm, and to lift my left shoulder up to touch my ear. I had this need to tense the muscles really hard. It was infuriating to have to keep doing it. I don't know if I'd call it an involuntary movement though. I could have not done those movements but it would have been insanely hard to resist that urge.
The forward posture in a person with drug induced parkinsonism is not from stiffness, but from another EPS symptom called 'camptocormia'. It a selective weakness in the back muscles, leading to a forward posture. Interesting extra subject for another small vid?
When I was 15 I had mild drug induced parkinson's, I was on Haldol and Thorazine. Had the tremor, stiffness, and shuffle. I was prescribed cogentin. I have been on Abilify for a couple weeks, so far I haven't had any issues.
I have akathisia with Reglan, compazine, haldol and benadryl. Some, like benadryl & Reglan, I only experience with an IV dose. What has always made me upset is, with some exceptions, I'm treated very suspiciously, even accused of being a drug addict. I don't understand the connection. It is a horrific feeling, esp bc I'm usually hooked up to wires and an IV so I can't go anywhere. I just pace the room. I am so thankful you've given a name to it that I can give a name to the dubious doctors. I feel so much less crazy. It also makes me angry they accuse me of lying when it's clear these EPS exist.
I have experiences Akathisia a number of times.... mostly medication induced. Once y an old psychiatric medication, Melleril. Other times by antiemetics in Ga's (such as metoclopramide, droperidol, stemitil IV). I was once given Cogentin to try and abate the effects. I would not wish it on my worst enemy and believe that too few doctors are aware of it and can write it off as "just" anxiety or restless leg syndrome. It is both of those multiplied by 1000 with an enormous sense of dread. It is enough, at times, to have suicidal ideation, to escape it. More education needs to be done on these EPSEs.
Very interesting video, thank you Dr Syl. I had an acute oculogyric crisis due to chlorpromazine many years ago. It was painful and distressing but resolved instantly after IM benztropine.
26:15 "Actually we don't really know why it happens." Honest truth many neurochemical effect - prescribed or otherwise occurs. Love it. signed, yours truly, a neuropsy geek
Just to be quirky and different I got akathisia from an SNRI (venlafaxine) and BOY does Dr Syl (as do most doctors) underplay the horror. This is something governments have deliberately induced in prisoners as a form of torture. You don't understand how vital 'rest and digest' is to your sanity until that ability is taken away. I've had panic attacks since then (they actually started soon after this experience), and although there are external similarities and people may use similar phrases to describe it, the internal experience of akathisia is unmistakeable. Your body physically can't keep still so you can't sleep, you're exhausted and achy and your body desperately craves to lie down and sleep but the moment you do it you feel the uncontrollable urge to move around again. This isn't due to anxiety, although the symptoms are accompanied by a similar sense of impending dread and adrenaline surge as a panic attack, but the difference is that agonising sensation of being unable to keep your muscles still. After 3 days pacing around 24/7 running on microsleeps you're beyond caring about anything because all you want is to knock out and sleep but your body just can't do it. You're a puppet on a string. You would kill to make it stop. If they can't treat it many sufferers self-exit and I would do exactly the same. Fortunately it is usually very treatable but that's only helpful if your GP knows what it is! Even though I was very clear with mine about being unable to sleep or keep my body still, no help was offered. Mine just heard 'new antidepressant' and 'anxiety' and was like yeah that's normal it'll probably get better in a few weeks. I think I lasted 4 days before I stopped taking the meds and in a couple of days I was pretty much back to my usual level of sh*t with some new fears unlocked. Now from my own research I know that I could have been treated easily that same day I called and been saved from an excruciatingly long 5 days of torture. GPs who prescribe psych meds please remember to be cautious about EPSEs! I was already not doing well but that experience left me with medical trauma that still affects me nearly a decade later. The whole situation led me to feel very alone like I couldn't trust my doctors or my own body. If anyone knows anything about the mechanisms of how SNRIs work that could help me understand why it can cause akathisia in some people I'd be very interested to learn more. I've asked a couple of psychiatrists now and both just said it's unusual and they don't know.
Understanding methylation, which is very complicated, could provide you with some insights into this, along with getting some genetic testing. I am ME/CFS for over 20 years with a history of psychosis and history of very bad experiences on anti-psychotics, a lot of it seems to come down to different nutritional/neuro-transmitter imbalances impacted by genes, and if some people are put on certain medications the disruption can compound already underlying issues. I have a few certain recessive genes for instance, like a MAO-A and a COMT, both these indicate an issue with breaking down certain neurotransmitters, so if I was put on something for instance which further creates even more neurotransmitters, like an SSRI or SNRI for instance it could become a nightmare because it is just producing more of what I can not break down properly already. These pathways can actually be corrected though with some basic vitamin supplementation and diet, and I need to be very careful with addictions and chasing/creating too much neurotransmitters. I don't know why a psych could not explain this too you, you have just likely ended with an excess of of serotonin or norepinephrine which has causes these symptoms, I wonder if it is even just a form of serotonin syndrome? Which is horrible as well I think in a similar way? I hope these days psych training involves some education in methylation and nutrition as it is so key to a lot of this stuff.
@@petecabrina woah I never heard about any of that. I've done a 23 and me but I don't remember seeing anything related to methylation. I'll have to look into it. Thank you! :)
@@Steph-zo5zk do you have the raw data from the test? There is some websites you can run the data through, which will give some results about detox/methylation genes, genetic genie is one, Dr Rhonda Patrick has one as well I think. You can also look at some doctors on YT taking about this, Dr Chris Masterjohn, Dr Dan Purser. When did you get the 23 and me test? I think if it is more recent some of the methylation genes are left out these days which they use to do. Depending what country you are in there can be specialist clinics in this field as well, and if you have the data already that is a great start.
@@Steph-zo5zk but yeah it sounds likely you just had serotonin syndrome from the anti-depressant, and doctors are typically so useless they won't even recognise that and either down play it or just assume its your own mental health issues playing up.
I have developed moderate akathisia shortly after starting my treatment for depression 10 years ago. I am on 100mg Sertraline (SSRI) daily and the akathisia is still with me to this day. I feel the need to fidget, move (especially my legs), I find it very difficult to sit still for even the shortest periods of time. Treatment with Lorazepam 1-2mg (Benzo) does not really help with the symptoms. I just learned to live with it all these years. It is not as debilitating for me as you showed in this video.
I developed an EPSE during an attempted med switch to abilify about 15yrs ago... was basically like having a pseudo torrets... all these yrs later and I still stim constantly to help cover the twitch and the stutter never fully left
I had akathisia for months. I didn’t know what it was. Waiting to see a psychiatrist and then eventually experimenting with new drugs took a very long time. I'm glad I stuck it out because we eventually found a drug with no akathisia.
I have had Dystonia due to medication. It has to be the worst side effect I have ever experienced. Even my tongue kept contracting, it lasted hours I was sweating perfusely, as if I had been working out the whole time. I had to have double the usual dose of antidote in order to get it to stop. The exhaustion after was unreal!
I have episodic laryngeal dystonia and diaphragmic dystonia resulting from neurologically involved Lyme's disease. It's painful and terrifying. One cool 'side effect' is that after a bout of it is over, my voice drops an octave for a few hours. Kinda nice to hear that rich baritone smokers rasp. 😅
Had dystonic reaction to compazine given in ER for nausea related to migraine. I popped up off the stretcher as all the sudden felt like something was wrong- like major anxiety. Told husband to go get someone but must have realized it was not good. They gave me Benadryl and I looked at them like they were crazy. Next thing I know it gets worse and I started to have dystonia I guess. Woke up to physician sitting next to me (unusual in our ER) to observe. Gave me Cogentin I was told that worked.
My brother developed akathisia while hospitalized and given two 1st gen antipsychotics which were used off label for either a cluster headache or a migraine. He was at tremendous risk for suicide and the worst thing about it was that whenever he went to the hospital for the extreme anxiety and depression and agitation they gave him one of the meds again!! It wasn’t taken seriously at all by doctors and he was treated like an agitated psych patient. It lasted on and off for weeks. We could have lost him and I think the doctor’s refusal to take it seriously was negligent. We could have lost him. thankfully he was able to make a recovery but the mental aspect of it is not well understood by ER doctors I think.
"It wasn’t taken seriously at all by doctors and he was treated like an agitated psych patient." Interesting to recognize how we are conditioned to know what this statement means, and to accept it for psych patients, who are having a neurological symptom not so different from a migraine - it just presents differently. Let's keep peeling back the layers of stigma which, so far, too easily can manifest as abusive treatment of psych patients.
So I went off my antipsychotic when I had the first sign of TD per doctors advice but the front desk did not understand that getting an appointment to get on something else was urgent. It was so frustrating! I ultimately lost my job. Now over 60 I have twitches and clenches. I’m getting relief from propranolol (US)
Gotta keep in mind with things like clozapine and Quetiapine, their lack of D2 affinity is only one part of their lack of EPSE but also a huge part is their highly anticholinergic effects, so they have the treatment built in. Nifty!
I had extremely tensed muscles after aripiprazole, then due to muscle stiftness I got tachycardia. Further, I got propranolol to manage this side effect, but then after taking propranolol my muscles relaxed and heart słowem down, but the restleness and anxiety moved from the heart to movements and I could not stop moving. I was walking from one room to another and couldn’t stop. Even after stopping with those meds, I could not walk far for many days and started to have tremors. It was really awful. I could not play the piano, because my hands were not working. A few weeks after stopping everything stopped luckily. When I was experiencing this, I thought I was just having tetany attacks (I also had it diagnosed years ago) and my blood test showed low calcium. But now that you are speaking about this - it was exactly this. There were involuntary muscle movements.
Actually I think if your movements/tic is occurring in response to a stimulus (like busy environments) it can be functional whereas if it's happening all the time irrespective of a stimulus it can be from the drug e.g tardive dyskinesia etc
Parkinsonism commonly associated with typical antipsychotics. I’ve seen some of these symptoms first hand back in nursing school when I did clinical rotation in a psychiatric/behavioral health unit.
I need to watch this another time. I work with people with learning disabilities and seen too much of these sign. Diagnostic overshadowing. There is a time and a place for this medication.
I struggle with akathisia whenever I am given metoclopramide (Reglan) to treat migraines. It’s among the antiemetics that are dopamine antagonists, so this tracks. It was quite distressing.
I've got rash, swollen lymph nodes, headache, raw mouth, (on olanzapine and lamcital. Went to see a nurse and she wouldn't take me seriously even though she saw the awful rash. When I looked it up it says it's dress syndrome so I'm not taking the lamictal again. My psychiatric nurse was very concerned but I got nowhere with the medical nurse. These side effects make me want to not take meds period, it's too hard.
I have but with medicine I took for an ear problem (labyrinthitis). The main problem was I started getting paralyzed all over and it was a bit scary. I was only on a very small dose of this medicine too. I switched to another medicine and was OK after that.
I have schizoaffective disorder and i take risperidone and epival as well as PRN benzos and prazosin for nightmares. I have a tremor in my right leg that i have never been properly assessed for. It’s better than it used to be and i mostly just live with it because my medications are working better than others i have been on. But the funny thing is that when the tremor is happening, i have the tendency to wonder if I’m anxious. As if my body were shaking from anxiety but i wasn’t having the emotion. That tends to MAKE me anxious. But I’m not anxious ABOUT the tremor if you understand my meaning, I’m being signalled by it.
I have bipolar 1 - ended up getting scheduled. Unfortunately have neurological conditions as well - including RLS - the treatment of which is dopamine agonists usually but I have managed with other medications for obvious reasons. I was put on an anti dopaminergic medication and I had the joy of akathesia during the day and severe RLS during the night kicking like a dog I would prefer severe migraine to distract me. It is frustrating in a public ward because while they knew I did neuroscience and would adapt tx to my ideas they had minimal time vs private. Furthermore, the nurse took my comment that the first drug I will come off was the antipsychotic and they went for a depot and I left all my family off the list in case something unfortunate happened - but I couldn't stand the idea of a depot (I would have to smoke weed or some other pharmacological intervention for the side effects if I couldn't get the otherwise algorithm to stop; would consult neurology and psychiatry and get a script for weed (not a fan but I was desperate if the psychiatrist was able to inflict the harm) on the TGA SAS - one way or another I would remedy the damage). I called one of my parents and due to position and the fact they discovered I had a family I was out in 2 days and I came off the antipsychotic immediately and my heath improved drastically (I was on lithium etc). I was frustrated and keeping that inside when someone is trying to give you an anticholinergic for my major problem RLS (anti-ACh not going to help) I don't have time or was feeling up to explaining why that would not help. DDX would be akathesia all day RLS night. Diff tx. The benefit of private hospitals is you can engage your multidisciplinary team of psychiatrist neurologist GP etc which frankly limited resources in public.
Years ago I was on Abilify (like many others in this comment section it seems) for only a month because I was so incredibly restless. Now (after many med changes) I've landed on Seroquel and it's almost having the opposite effect, I sit incredibly still and don't feel like moving at all, not sure if that's part of it's sedating quality or not.
Hey! Dr Syl! I'm just wondering - Is there a link between akathisia and restless legs syndrome? I have that, and it sounds very similar.... I also have MS, but my neurologist cant really explain the restless legs. I take antidepressants, and I'm starting to think that there's link here.
I am sure Dr Syl has a much more eloquent explanation of the link between akathesia and RLS. In the video he talked about dopaminergic pathways in the brain - that the primary over lap. You block dopamine in RLS -> worse : you boost dopamine -> improvement (there are other drugs to treat RLS like gabapentanoids that do not affect dopamine directly). Drugs that are not classed as antipsychotics usually also block dopamine or affect the pathway there are other causes but the fundamental similarity is dopamine. For reasons I won't go into for brevity anti cholinergic drugs like benzatropine are used for akaethesia whereas first line drugs for RLS are usually increase dopamine. To steal from wikipedia "Benzatropine is a centrally acting anticholinergic/antihistamine agent. It is a selective M1 muscarinic acetylcholine receptor antagonist. Benzatropine partially blocks cholinergic activity in the basal ganglia and has also been shown to increase the availability of dopamine by blocking its reuptake and storage in central sites, and as a result, increasing dopaminergic activity." [MIMS Australia Pty Ltd. MIMS. - expensive drug book unless your an academic] I looked at the latest copy and it had this about the ratio of acetylcholine to dopamine so take Wikipedia for what its worth although its in keeping with my current understanding. "Its anticholinergic effects have been established as therapeutically significant in the management of parkinsonism. Benztrop antagonises the effect of acetylcholine, decreasing the imbalance between the neurotransmitters acetylcholine and dopamine, which may improve the symptoms of early Parkinson's disease." One is seen during the day akathesia one at night RLS. To steal from wikipedia "Research and brain autopsies have implicated both dopaminergic system and iron insufficiency in the substantia nigra.[40] Iron is well understood to be an essential cofactor for the formation of L-dopa, the precursor of dopamine." [Connor, J.R.; Boyer, P.J.; Menzies, S.L.; Dellinger, B.; Allen, R.P.; Ondo, W.G.; Earley, C.J. (2003). "Neuropathological examination suggests impaired brain iron acquisition in restless legs syndrome". Neurology. 61 (3): 304-9.]
I have what is called localized Akathesia ! It is isolated to my low back on both sides of my tail bone! It isn't constant but when it acts up i can not sit or lay still! It happens most often when i lie in bed to sleep! I can not lay still...i bounch, rock, kick, push my feet against the foot board over and over! I look posessed! It is enough to make me genuinely, literally go insane! The only thing i can do is get out of bed and pace back and forth, in circles, change direction, bend and twist etc till i am so exhausted I try laying in bed again! It continues and i go through the bouncing, rocking, kicking routine again and this continues until i eventually pass out! Ugh! Thankfully this doesn't happen every night ! There is no rhyme or reason for this! Have no answers for why this happens yet! Been going through this for over 10 yrs now!
I had a really horrible combination of extrapyramidial side effects. My story is actually quite horrid. I started with dealing with terrible depression and being given NUMEROUS psychotropic medications and I felt they weren't effective and didn't want to take them and I was put into a group home forced to take numerous meds. I developed akathisia first and it was insanely uncomfortable and I didn't want to stay... They gave more meds I had to take which caused some dystonia and eventually extreme tardive dyskinesia and I begged them to stop but they tried more and more meds. This all transpired over about 6 years. Eventually I was visiting my sister and she said oh my gosh did you feel that your face just did that? And I hadn't. I got a referral for a neurologist and had an 8 hour neuropsychological evaluation. I had to do physical, computer, writing etc testing. At this point I was diagnosed with Tourette's also chemically induced Tourette's, Autism and severe Anxiety. So, if you didn't catch it, I have Tourette's for the rest of my life because of the massive amount of medications pumped into my body that I had no choice over. You can see some of my videos on @Atypicallyuntypical
Akathesia is HORRIBLE! A terrible inner restlessness very unlike anxiety. Totally separate from anxiety. I wanted to tear myself apart. Feels as though you want to 'escape' from your own body/turn yourself inside out. Moving feels as though it should help but it doesn't. Happened to me when I 1st took antipsychotics and then when I changed to a new one. Diazepam helped a little.
Hello, Dr. Syl! Could you please comment on Lauren from “Living Well with Schitzophrenia”. She’s been on quite a journey with medical keto. Curious to learn what your opinion is. Thank you! ☺️
Dr Syl, I take a fairly high dose of Pristiq and Valium for anxiety. I have what I feel is tardive dystopia of the mandibular variety.. It seems really minor compared to the extreme cases you have identified in your video, but my jaw is becoming displaced and I am biting my cheek. Being such a mild case, I wonder if it is the SNRI, the benzo or the anxiety. I started by asking my doc to reduce my SNRI med, but it doesn’t seem to be getting better. I go to cognitive therapy every other week. I have been on some form of SSRI or SNRI and benzo for over 20 years… Any thoughts would be appreciated as to next steps.
My husband has MS and he once had an episode where all of his muscles started spasming. His neck, arms, legs, head. Are any of these conditions sometimes found in MS patients? He doesn’t have a history of anti-psychotic medication.
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I found one of the best representations of what it’s like to have a delusion. The show is called Black Mirror (season two, episode 2). Episode name: White Bear. There is a huge psychological component to this episode; it can be looked at as a delusion of grandeur or persecution-at least in the untrained eyes of aspiring medical students.
I know someone (i wont say who bc of the details) who was diagnosed with tartive dysk. They were on an antidepressant; To my knowledge, the duration of time is unknown but definitely under seven years (maybe like 2). Also, this person was in active addiction, using methamphetamines. His symptoms would exacerbate while high. Is it possible all of it was from the illicit drug use, or 100% from the anti depressant? (Again, I'm pretty sure he was on an anti depressant and not an antipsychotic). He had very severe symptoms, sticking his entire tounge out of his mouth, moving his mouth around and also making odd sounds. This same person, also did the other symptom (sorry I already forgot the name) where they cannot sit/stand still, whatsoever. Thank you!
This subject matter always annoys me because of the extent of playing down of side effects over the decades and damage done to people, especially those being put on anti-psychotics off label, which should never happen. Is the doc aware of the AstraZeneca lawsuit over Seroquel? And how the company convinced everyone to off label it, and even after the lawsuit and damage it did to so many it can still be off labelled today, by completely naive GP's. I really hope future doctors and doctors like Syl realise the seriousness of these drugs and the problems they cause, and that they shouldn't be off labelled, especially to kids for non related issues or other mood issues. Even found a psychiatrist from Wollongong on here talking about this and why he does not off label Seroquel anymore, after my GP tried to get me on 100mg dose, because of supposed chronic anxiety which I do not even have and which she often presumes is my main problem.
Not sure if this is akathesia but i find my foot mostly my right one moves up an down when im in bed. Im totally unaware of it until i become aware if that makes sense. Also i rub the thumb up and down the first joint of my index finger constantly, day and night Again im not aware im doing it until i notice and when i stop noticing it starts straight up again
From your description this doesn't sound like akathisia. Akathisia is very distressing and affects the whole body, making it impossible to stay still for any length of time meaning no ability to sit sleep or rest. It's common for neurotypical people to do things like bouncing feet and repetitive hand movements just as a habit, but it's especially common for people with ASD/ADHD often as a way to calm ourselves or improve our ability to focus.
Have you spoken about catatonia and treatments. The one time I have seen a severe case on the ward (community mh clinician and visiting a client)and I will never forget the stare. He would still sort of interact but had to be directed to move, lost body function control, stopped eating but you could sort of talk to them. But the what and why and the role of ECT and other treatments.
I would like to see a video on psychogenic polydipsia. I experience this. I also had a lithium toxicity in February where my kidneys almost completely shut down. If there is content enough about that, please make a video!
In a world where everything from depression to eating disorders to schizophrenia are being reversed by metabolic interventions, with the ketogenic diet being the strongest lever, it's very hard for me to understand why every person connected with the field of psychiatry is not breaking down doors to learn everything they can about this new approach and to help the people they work with obtain relief.
I had a friend that talked like a Bulldozer (New Yorker) when I jumped in, He would stop vocalizing but his lips would keep mumbling his thought. We would still be friends but he would "fake" punch me in the face & after 2 black eyes I had to move...
I have the same!!! And I am missing holistic approach. I also experience some physical problems that I am having herbs for - and the problem is also that I can not take those herbs with antipsychotics and then my general heath declines. On the other hand, without medications i do not function well, I forget meals and spend a lot of money. It is horrible choice - that I have to choose something that hurts my body to be able to nourish it correctly.
My late sister had both anerexia and bulemia growing up . Do you have insight on eating disorders ? If you're interested I have a song/ video I would like to request and a two minute ' behind the scenes ' insightful docu. short that has a little more insight beyond the song / video. It features a famous Norweigan photographer who died from 18 years of anerexia . The 2 minute short : ' The Self Portrait / AFF 2020 ' Astra Film Festival channel Susanne Sundfor did the vocals / and worked on the soundtrack of a documentary about Lene Marie Fossen : ' A self portrait ' The video was skillfully edited from scenes of that documentary . The song / video is ' When the lord ' Susanne Sundfor Susanne Sundfor channel .
I’ve been treating bipolar disorder for some years and there are some medications used in it I’ve learned through the years that causes dystonia in me, the tongue symptoms as well as the head as if there’s pressure or a magnet on and inside them. Like a heavy anchor pulling inside the head snd mouth. The antipsychotics ones such as risperidone, ziprasidone(this one is harder than the others) quetiapine and topiramate. I still take risperidone, in a very low dosage but i also take biperiden as an antidote because it’s random if I have a side effect or not. In doubt I take it. Those symptoms are awful to endure, work study and live with. That’s one of the few videos about it I came across a few years ago th-cam.com/video/rqhhYnYoOZo/w-d-xo.htmlsi=rzfPvPcHBSEPD6ft
❤ Thank you! I had a bad reaction while hospitalized for intractable migraine. I was given a fast IV push of Reglan. I had taken it orally before with no reaction. That day, the nurse quickly pushed directly into my IV. I had akathisia and a panic attack. I ripped the IV out and left the hospital in my gown. It was a taste of what others go through when living with these sort of symptoms. Rough. 🫠 Don’t administer this way!
When I got reglan in the ER, they gave me an IV push of benadryl 10 minutes before administering it to make me drowsy and cut down on the negative side effects. Definitely made it better!
Got a severe case of TD (whole body and face, really big movements), some days I couldn't even walk. It started 3 months after I began the medication (SSRI 🥲), so I didn't initially make the connection, and lasted a couple of months after coming off - now I have a tic disorder, I think an FND type thing, when stressed or when I see someone with tourettes or something, this video may set me off for a couple of weeks. Thankfully, it's not as bad as the TD. I remember being upset about the facial movements which lasted well after the body movements stopped. I was scowling, grimacing and sneering alot, and I was worried it would last forever and I wouldn't be able to get a job or work because I couldn't contol my face. I was on valium for a little bit too, which didn't help with the movements but at least I was relaxed about it.
I had dystonia from taking latuda and rexulti. I couldn’t put my tongue back in my mouth and it was so uncomfortable and scary. They gave me benztropine in the emergency room and it went away quickly. I’ve taken other antipsychotics that didn’t cause dystonia, but a lot of them caused weight gain. I’m on lybalvi now and that has been weight neutral and hasn’t caused dystonia.
I developed akathisia from intramuscular maxolon! It was absolutely horrendous wouldn't wish it on my worst enemy. It took hours for it to wear off. I thought I was crawling out of my skin.
😮
I am currently experiencing dyskinesia after stopping Abilify. The hope is that it is a symptom of withdrawal and will go away. It has been so upsetting and also painful. I am a psych nurse and this has really opened my eyes to what my patients may be feeling struggling with EPS.
Yes, it is. I have experienced horror after this medication and while withdrawing this medication.
When I was in hospital for my treatment resistant psychosis I tried many different medications that weren’t working, finally got put on a different first generation antipsychotic, started at a decent dose and developed akathisia as well as some mild dystonia. Let me say that akathisia is one of the worst things I have ever experienced. I truly felt like I was dying, I was really thinking I was gonna die in hospital. The literal definition of feeling like you’re crawling out of your skin, but worse somehow.
Newly qualified MH nurse here, thank you for the info, I knew about EPSEs obviously but it's all quite confusing , so will be saving this and coming back to it so I can better look out for these in my patients 😊
It's not just psychiatric medicine that can do this - I had something to treat an inner ear problem which gave me some of these problems so be aware it can be a range of medicines.
I had acute dystonia from taking haloperidol while I was hospitalized and it was almost traumatic, I was literally begging doctors to make it stop. they gave me biperiden im and it didn't work at all so they switched to iv and the relief was indescribable
My mother got drug induced parkinsonism. Hallucinations and all. It was terrifying
Love your channel. As a new grad nurse entering into behavioral health I am unable to how appreciative I am for the knowledge I have acquired from your videos.
I have tardive dyskinesia from taking Haldol, followed by respiridone since 1984. I was switched to clozapine but I had bad blood work. I had one psychiatrist who applied for a grant to get a medication covered to help with it. I'm in Canada, and although health care is universal, drug coverage is not. My care was passed to a different psychiatrist when that one retired and the current doctor is not pursuing the grant. His idea is to decrease the respiridone so that the side effects are less. It really is frustrating to have this side effect. I find the hardest thing is the trip to the dentist. The hygienist is never educated about it, and I get tired of explaining it. At least dentist's are taught about it, but if I see a new one, I have to remind them from their training. I can control it, but not for a whole dental thing. It also affects your appearance. As 8f people see you on the bus or whatever, you aren't just sitting still. Your mouth is moving. People associate this with mental illness, which is often invisible. Not so in my case.
I can’t even imagine how awful that would be and never thought about how that would impact seeing the dentist! I’m so sorry you have to go through that! God bless u and i hope you can somehow find some peace!
I was put on 10mg of abilify in the hospital, it was the first time i was taking it. I developed a muscle twitching in the face and akathesia! It was a nightmare! But, i still continued to take it at a lower dose. I am now completely of it now! So happy!
Hi what lower dose was liveable please. Im in same position 10mg abilify and akathesia. In so much pain. Ive reduced to 7.5mg but prob need lower.
5mg, was good for me!❤ try that, or they even have 2mg!
Thank you so much for replying .ive halved down to 5mg but still needing opiates to counter the akethesia but only day 3
Thanks so much for replying. Im day 3 on 5mg. But needing opiates to counter the akethesia.hoping in a week or so i can go without and cope ok on 5mg without the benzos. Thank you
I was searching for information on these. Working with autistic people, they often take medication that can give them side effects and people don't always know to look out for those. I wanted to see examples because I read a lot on it, but wanted to see what every symptom looks like. As a special educator, it's really valuable to have subscribed to you! Merci beaucoup Dr Syl!
I developed Akathisa from Latuda and it was THE worst feeling I have ever experienced hands down. Every muscle in my body had this extreme unrelenting need to move, but no matter how much I moved, the feeling was never satisfied in the slightest. I had not been warned of the possibility of this side effect by my doctor, which caused a lot of anxiety and panic as I felt like my skin was crawling and I wanted to rip my skin off my body as it was just so horrible. I would not wish this on my worst enemy.
Dr. Syl, you do such a great job of teaching and explaining complex concepts. Your channel might be the most interesting one on youtube. Thank you so much for covering these important concepts as I'm sure it helps sufferers of these conditions feel not so alone and that there is hope for them.
I got Tardive Tourettism from Abilify, I have vocal and motor tics that are somewhat suppressible around people, they go down to minor tics when I socialize and go up when I'm alone to phrases and gestures.
Doctor, I just want you to know how much you're helping do these videos sir. The only suggestion I might add is trying to make videos specifically for children if possible, I got started in mental health at 5 years old maybe not that young but certainly as a preteen and teen your videos wouldve been a boon back then.
I have dealt with akathisia from several antipsychotic medications including the one im currently on. Its very difficult to manage and very distressing. But i have been willing to manage it to have some quality of life when it comes to my mood symptoms.
I developed Akathesia. It was the worst thing that ever happened to me. I also had dyskinesia too. Thankfully it went away otherwise I knew I wasn’t going to be able to live anymore cuz it was so distressing. I told the psychiatrist and he said try a different one, and I said no I’m not doing it again. He didn’t believe me, obviously I didn’t k or what happened at the time but I found out a yr later.
Having been a RN I saw so many RN’s push IV Metoclopramide in fast. They didn’t even understand EPS.
Greetings from Canada 🇨🇦
I really appreciate your videos as they are very informative. You kind, personable and gentle delivery makes them enjoyable. I think you’ll be a fabulous Psychiatrist! 😊
I had dystonia from taking metoclopramide. I had intense nausea and I took one pill, then I don't remember why I was taken to the ER, and I don't know why the doctors didn't ask if I had taken anything before injecting me with more metoclopramide. When I got back home my neck and shoulder started twisting against each other involuntarily.
Funny thing is, I've taken an array of actual psychiatric medications over the years for depression, anxiety, and OCD, and I've never had extra pyramidal symptoms with antidepressants or antipsychotics.
had this from taking solian, it's the worst I ever felt physically.
I got an acute dystonic reaction from Abilify once. It was horrible. It was a severe reaction as well. I felt like it started out with akathisia as well. At least I felt severley restless and didn't know why. Then my neck started twitching more and more. In th end my whole neck and trunk started twisting backwards kind of. It was so distressful. Had to recieve several shots to contradtict the effect of Abilify (I think, I don't really know what I got, but after a few hours, it was all good).
I also had a lot of tremors for years. Not like this parkinsonism, just light tremors all the time and sometimes so severe it was hard to eat (like lifting the fork to my mouth). Also had some kind of movement issue in one of my feets. It kind of sounds like tardive dyskinesa, but again, it was my foot and not my face. It was an unconcious movement all the time as long as I was resting. I could force it to stop, but it would start again if I stopped thinking about it. Both of these issues resolved themselves when I quit that particular med, thankfully.
I wish people would remember it's not just anti-psychotics that trigger EPS. I've had short-term akathisia from an anti-nausea med (Maxolon) and an anti-histamine (Phenergen), along with a weird movement thing.
I experienced akathisia in hospital right after being given an anti-nausea med (Maxolon). It was the worst feeling I've ever experienced! I suddenly wanted to tear my skin off and escape my body. Every atom in my body wanted to escape. It only lasted an hour or so, but I would've wanted to die if it had gone on any longer. It was excruciating.
Like another comment on here said, it is NOT like anxiety.
It was literally the middle of the night on the ward, so it was just the night duty nurses who were there. I'm pretty sure they assumed I was just having a random 'panic attack' or something the night before a procedure, and were trying to calm me down. No one at the hospital put it together that I had actually had an adverse reaction to a medication they gave me.
I also kept NEEDING to bend my left arm, and to lift my left shoulder up to touch my ear. I had this need to tense the muscles really hard. It was infuriating to have to keep doing it. I don't know if I'd call it an involuntary movement though. I could have not done those movements but it would have been insanely hard to resist that urge.
The forward posture in a person with drug induced parkinsonism is not from stiffness, but from another EPS symptom called 'camptocormia'. It a selective weakness in the back muscles, leading to a forward posture. Interesting extra subject for another small vid?
When I was 15 I had mild drug induced parkinson's, I was on Haldol and Thorazine. Had the tremor, stiffness, and shuffle. I was prescribed cogentin. I have been on Abilify for a couple weeks, so far I haven't had any issues.
I have akathisia with Reglan, compazine, haldol and benadryl. Some, like benadryl & Reglan, I only experience with an IV dose.
What has always made me upset is, with some exceptions, I'm treated very suspiciously, even accused of being a drug addict. I don't understand the connection.
It is a horrific feeling, esp bc I'm usually hooked up to wires and an IV so I can't go anywhere. I just pace the room.
I am so thankful you've given a name to it that I can give a name to the dubious doctors. I feel so much less crazy. It also makes me angry they accuse me of lying when it's clear these EPS exist.
Thank you, Dr. syl I am a community nurse, and this helps me greatly in understanding the people i care for
Thanks for another super interesting and informative video 😊 you should come to the UK ! 🇬🇧. Thank you for your content
I have experiences Akathisia a number of times.... mostly medication induced. Once y an old psychiatric medication, Melleril. Other times by antiemetics in Ga's (such as metoclopramide, droperidol, stemitil IV). I was once given Cogentin to try and abate the effects. I would not wish it on my worst enemy and believe that too few doctors are aware of it and can write it off as "just" anxiety or restless leg syndrome. It is both of those multiplied by 1000 with an enormous sense of dread. It is enough, at times, to have suicidal ideation, to escape it. More education needs to be done on these EPSEs.
Very interesting video, thank you Dr Syl. I had an acute oculogyric crisis due to chlorpromazine many years ago. It was painful and distressing but resolved instantly after IM benztropine.
26:15 "Actually we don't really know why it happens." Honest truth many neurochemical effect - prescribed or otherwise occurs. Love it. signed, yours truly, a neuropsy geek
Just to be quirky and different I got akathisia from an SNRI (venlafaxine) and BOY does Dr Syl (as do most doctors) underplay the horror. This is something governments have deliberately induced in prisoners as a form of torture. You don't understand how vital 'rest and digest' is to your sanity until that ability is taken away. I've had panic attacks since then (they actually started soon after this experience), and although there are external similarities and people may use similar phrases to describe it, the internal experience of akathisia is unmistakeable. Your body physically can't keep still so you can't sleep, you're exhausted and achy and your body desperately craves to lie down and sleep but the moment you do it you feel the uncontrollable urge to move around again. This isn't due to anxiety, although the symptoms are accompanied by a similar sense of impending dread and adrenaline surge as a panic attack, but the difference is that agonising sensation of being unable to keep your muscles still. After 3 days pacing around 24/7 running on microsleeps you're beyond caring about anything because all you want is to knock out and sleep but your body just can't do it. You're a puppet on a string. You would kill to make it stop. If they can't treat it many sufferers self-exit and I would do exactly the same.
Fortunately it is usually very treatable but that's only helpful if your GP knows what it is! Even though I was very clear with mine about being unable to sleep or keep my body still, no help was offered. Mine just heard 'new antidepressant' and 'anxiety' and was like yeah that's normal it'll probably get better in a few weeks. I think I lasted 4 days before I stopped taking the meds and in a couple of days I was pretty much back to my usual level of sh*t with some new fears unlocked. Now from my own research I know that I could have been treated easily that same day I called and been saved from an excruciatingly long 5 days of torture.
GPs who prescribe psych meds please remember to be cautious about EPSEs! I was already not doing well but that experience left me with medical trauma that still affects me nearly a decade later. The whole situation led me to feel very alone like I couldn't trust my doctors or my own body.
If anyone knows anything about the mechanisms of how SNRIs work that could help me understand why it can cause akathisia in some people I'd be very interested to learn more. I've asked a couple of psychiatrists now and both just said it's unusual and they don't know.
Understanding methylation, which is very complicated, could provide you with some insights into this, along with getting some genetic testing. I am ME/CFS for over 20 years with a history of psychosis and history of very bad experiences on anti-psychotics, a lot of it seems to come down to different nutritional/neuro-transmitter imbalances impacted by genes, and if some people are put on certain medications the disruption can compound already underlying issues. I have a few certain recessive genes for instance, like a MAO-A and a COMT, both these indicate an issue with breaking down certain neurotransmitters, so if I was put on something for instance which further creates even more neurotransmitters, like an SSRI or SNRI for instance it could become a nightmare because it is just producing more of what I can not break down properly already. These pathways can actually be corrected though with some basic vitamin supplementation and diet, and I need to be very careful with addictions and chasing/creating too much neurotransmitters.
I don't know why a psych could not explain this too you, you have just likely ended with an excess of of serotonin or norepinephrine which has causes these symptoms, I wonder if it is even just a form of serotonin syndrome? Which is horrible as well I think in a similar way? I hope these days psych training involves some education in methylation and nutrition as it is so key to a lot of this stuff.
@@petecabrina woah I never heard about any of that. I've done a 23 and me but I don't remember seeing anything related to methylation. I'll have to look into it. Thank you! :)
@@Steph-zo5zk do you have the raw data from the test? There is some websites you can run the data through, which will give some results about detox/methylation genes, genetic genie is one, Dr Rhonda Patrick has one as well I think. You can also look at some doctors on YT taking about this, Dr Chris Masterjohn, Dr Dan Purser. When did you get the 23 and me test? I think if it is more recent some of the methylation genes are left out these days which they use to do. Depending what country you are in there can be specialist clinics in this field as well, and if you have the data already that is a great start.
@@Steph-zo5zk but yeah it sounds likely you just had serotonin syndrome from the anti-depressant, and doctors are typically so useless they won't even recognise that and either down play it or just assume its your own mental health issues playing up.
I have developed moderate akathisia shortly after starting my treatment for depression 10 years ago. I am on 100mg Sertraline (SSRI) daily and the akathisia is still with me to this day. I feel the need to fidget, move (especially my legs), I find it very difficult to sit still for even the shortest periods of time. Treatment with Lorazepam 1-2mg (Benzo) does not really help with the symptoms. I just learned to live with it all these years. It is not as debilitating for me as you showed in this video.
I developed an EPSE during an attempted med switch to abilify about 15yrs ago... was basically like having a pseudo torrets... all these yrs later and I still stim constantly to help cover the twitch and the stutter never fully left
Great talk!!
Loving your videos!
I am a first year psychiatry registrar in Victoria, would love you to do a talk on PRNs! :)
I had akathisia for months. I didn’t know what it was. Waiting to see a psychiatrist and then eventually experimenting with new drugs took a very long time. I'm glad I stuck it out because we eventually found a drug with no akathisia.
I have had Dystonia due to medication. It has to be the worst side effect I have ever experienced. Even my tongue kept contracting, it lasted hours I was sweating perfusely, as if I had been working out the whole time. I had to have double the usual dose of antidote in order to get it to stop. The exhaustion after was unreal!
Very, very interesting. Greetings from Spain
I have episodic laryngeal dystonia and diaphragmic dystonia resulting from neurologically involved Lyme's disease. It's painful and terrifying. One cool 'side effect' is that after a bout of it is over, my voice drops an octave for a few hours. Kinda nice to hear that rich baritone smokers rasp. 😅
Had dystonic reaction to compazine given in ER for nausea related to migraine. I popped up off the stretcher as all the sudden felt like something was wrong- like major anxiety. Told husband to go get someone but must have realized it was not good. They gave me Benadryl and I looked at them like they were crazy. Next thing I know it gets worse and I started to have dystonia I guess. Woke up to physician sitting next to me (unusual in our ER) to observe. Gave me Cogentin I was told that worked.
EPSE's is the reason I had to come off the mental health meds I was on this winter and then try a new one. It was so distressing to experience.
My brother developed akathisia while hospitalized and given two 1st gen antipsychotics which were used off label for either a cluster headache or a migraine. He was at tremendous risk for suicide and the worst thing about it was that whenever he went to the hospital for the extreme anxiety and depression and agitation they gave him one of the meds again!! It wasn’t taken seriously at all by doctors and he was treated like an agitated psych patient. It lasted on and off for weeks. We could have lost him and I think the doctor’s refusal to take it seriously was negligent. We could have lost him. thankfully he was able to make a recovery but the mental aspect of it is not well understood by ER doctors I think.
"It wasn’t taken seriously at all by doctors and he was treated like an agitated psych patient." Interesting to recognize how we are conditioned to know what this statement means, and to accept it for psych patients, who are having a neurological symptom not so different from a migraine - it just presents differently. Let's keep peeling back the layers of stigma which, so far, too easily can manifest as abusive treatment of psych patients.
So I went off my antipsychotic when I had the first sign of TD per doctors advice but the front desk did not understand that getting an appointment to get on something else was urgent.
It was so frustrating! I ultimately lost my job.
Now over 60 I have twitches and clenches. I’m getting relief from propranolol (US)
Gotta keep in mind with things like clozapine and Quetiapine, their lack of D2 affinity is only one part of their lack of EPSE but also a huge part is their highly anticholinergic effects, so they have the treatment built in. Nifty!
Could you do a video on diet and mental health This seems to be a lot of videos on the keynote diet and schizophrenia
I had extremely tensed muscles after aripiprazole, then due to muscle stiftness I got tachycardia. Further, I got propranolol to manage this side effect, but then after taking propranolol my muscles relaxed and heart słowem down, but the restleness and anxiety moved from the heart to movements and I could not stop moving. I was walking from one room to another
and couldn’t stop. Even after stopping with those meds, I could not walk far for many days and started to have tremors. It was really awful. I could not play the piano, because my hands were not working. A few weeks after stopping everything stopped luckily.
When I was experiencing this, I thought I was just having tetany attacks (I also had it diagnosed years ago) and my blood test showed low calcium. But now that you are speaking about this - it was exactly this. There were involuntary muscle movements.
Actually I think if your movements/tic is occurring in response to a stimulus (like busy environments) it can be functional whereas if it's happening all the time irrespective of a stimulus it can be from the drug e.g tardive dyskinesia etc
Parkinsonism commonly associated with typical antipsychotics. I’ve seen some of these symptoms first hand back in nursing school when I did clinical rotation in a psychiatric/behavioral health unit.
I need to watch this another time. I work with people with learning disabilities and seen too much of these sign. Diagnostic overshadowing. There is a time and a place for this medication.
I struggle with akathisia whenever I am given metoclopramide (Reglan) to treat migraines. It’s among the antiemetics that are dopamine antagonists, so this tracks. It was quite distressing.
I experienced akathisia going through opiate/opioid withdrawal, it's the symptom I fear the most!
I've got rash, swollen lymph nodes, headache, raw mouth, (on olanzapine and lamcital. Went to see a nurse and she wouldn't take me seriously even though she saw the awful rash. When I looked it up it says it's dress syndrome so I'm not taking the lamictal again. My psychiatric nurse was very concerned but I got nowhere with the medical nurse. These side effects make me want to not take meds period, it's too hard.
I have but with medicine I took for an ear problem (labyrinthitis). The main problem was I started getting paralyzed all over and it was a bit scary. I was only on a very small dose of this medicine too. I switched to another medicine and was OK after that.
I have schizoaffective disorder and i take risperidone and epival as well as PRN benzos and prazosin for nightmares. I have a tremor in my right leg that i have never been properly assessed for. It’s better than it used to be and i mostly just live with it because my medications are working better than others i have been on. But the funny thing is that when the tremor is happening, i have the tendency to wonder if I’m anxious. As if my body were shaking from anxiety but i wasn’t having the emotion. That tends to MAKE me anxious. But I’m not anxious ABOUT the tremor if you understand my meaning, I’m being signalled by it.
I have bipolar 1 - ended up getting scheduled. Unfortunately have neurological conditions as well - including RLS - the treatment of which is dopamine agonists usually but I have managed with other medications for obvious reasons.
I was put on an anti dopaminergic medication and I had the joy of akathesia during the day and severe RLS during the night kicking like a dog I would prefer severe migraine to distract me.
It is frustrating in a public ward because while they knew I did neuroscience and would adapt tx to my ideas they had minimal time vs private.
Furthermore, the nurse took my comment that the first drug I will come off was the antipsychotic and they went for a depot and I left all my family off the list in case something unfortunate happened - but I couldn't stand the idea of a depot (I would have to smoke weed or some other pharmacological intervention for the side effects if I couldn't get the otherwise algorithm to stop; would consult neurology and psychiatry and get a script for weed (not a fan but I was desperate if the psychiatrist was able to inflict the harm) on the TGA SAS - one way or another I would remedy the damage).
I called one of my parents and due to position and the fact they discovered I had a family I was out in 2 days and I came off the antipsychotic immediately and my heath improved drastically (I was on lithium etc). I was frustrated and keeping that inside when someone is trying to give you an anticholinergic for my major problem RLS (anti-ACh not going to help) I don't have time or was feeling up to explaining why that would not help.
DDX would be akathesia all day RLS night. Diff tx.
The benefit of private hospitals is you can engage your multidisciplinary team of psychiatrist neurologist GP etc which frankly limited resources in public.
Years ago I was on Abilify (like many others in this comment section it seems) for only a month because I was so incredibly restless. Now (after many med changes) I've landed on Seroquel and it's almost having the opposite effect, I sit incredibly still and don't feel like moving at all, not sure if that's part of it's sedating quality or not.
Hey! Dr Syl! I'm just wondering - Is there a link between akathisia and restless legs syndrome? I have that, and it sounds very similar.... I also have MS, but my neurologist cant really explain the restless legs. I take antidepressants, and I'm starting to think that there's link here.
I am sure Dr Syl has a much more eloquent explanation of the link between akathesia and RLS.
In the video he talked about dopaminergic pathways in the brain - that the primary over lap. You block dopamine in RLS -> worse : you boost dopamine -> improvement (there are other drugs to treat RLS like gabapentanoids that do not affect dopamine directly).
Drugs that are not classed as antipsychotics usually also block dopamine or affect the pathway there are other causes but the fundamental similarity is dopamine. For reasons I won't go into for brevity anti cholinergic drugs like benzatropine are used for akaethesia whereas first line drugs for RLS are usually increase dopamine.
To steal from wikipedia "Benzatropine is a centrally acting anticholinergic/antihistamine agent. It is a selective M1 muscarinic acetylcholine receptor antagonist. Benzatropine partially blocks cholinergic activity in the basal ganglia and has also been shown to increase the availability of dopamine by blocking its reuptake and storage in central sites, and as a result, increasing dopaminergic activity." [MIMS Australia Pty Ltd. MIMS. - expensive drug book unless your an academic]
I looked at the latest copy and it had this about the ratio of acetylcholine to dopamine so take Wikipedia for what its worth although its in keeping with my current understanding.
"Its anticholinergic effects have been established as therapeutically significant in the management of parkinsonism. Benztrop antagonises the effect of acetylcholine, decreasing the imbalance between the neurotransmitters acetylcholine and dopamine, which may improve the symptoms of early Parkinson's disease."
One is seen during the day akathesia one at night RLS.
To steal from wikipedia "Research and brain autopsies have implicated both dopaminergic system and iron insufficiency in the substantia nigra.[40] Iron is well understood to be an essential cofactor for the formation of L-dopa, the precursor of dopamine."
[Connor, J.R.; Boyer, P.J.; Menzies, S.L.; Dellinger, B.; Allen, R.P.; Ondo, W.G.; Earley, C.J. (2003). "Neuropathological examination suggests impaired brain iron acquisition in restless legs syndrome". Neurology. 61 (3): 304-9.]
When would you discontinue the benztropine if the pt is on a typical AP as an outpatient? Also, can you make a video on metabolic psychiatry
I have what is called localized Akathesia ! It is isolated to my low back on both sides of my tail bone! It isn't constant but when it acts up i can not sit or lay still! It happens most often when i lie in bed to sleep! I can not lay still...i bounch, rock, kick, push my feet against the foot board over and over! I look posessed! It is enough to make me genuinely, literally go insane! The only thing i can do is get out of bed and pace back and forth, in circles, change direction, bend and twist etc till i am so exhausted I try laying in bed again! It continues and i go through the bouncing, rocking, kicking routine again and this continues until i eventually pass out! Ugh! Thankfully this doesn't happen every night ! There is no rhyme or reason for this! Have no answers for why this happens yet! Been going through this for over 10 yrs now!
I had a really horrible combination of extrapyramidial side effects. My story is actually quite horrid. I started with dealing with terrible depression and being given NUMEROUS psychotropic medications and I felt they weren't effective and didn't want to take them and I was put into a group home forced to take numerous meds. I developed akathisia first and it was insanely uncomfortable and I didn't want to stay... They gave more meds I had to take which caused some dystonia and eventually extreme tardive dyskinesia and I begged them to stop but they tried more and more meds. This all transpired over about 6 years. Eventually I was visiting my sister and she said oh my gosh did you feel that your face just did that? And I hadn't. I got a referral for a neurologist and had an 8 hour neuropsychological evaluation. I had to do physical, computer, writing etc testing. At this point I was diagnosed with Tourette's also chemically induced Tourette's, Autism and severe Anxiety. So, if you didn't catch it, I have Tourette's for the rest of my life because of the massive amount of medications pumped into my body that I had no choice over. You can see some of my videos on @Atypicallyuntypical
Akathesia is HORRIBLE! A terrible inner restlessness very unlike anxiety. Totally separate from anxiety. I wanted to tear myself apart. Feels as though you want to 'escape' from your own body/turn yourself inside out. Moving feels as though it should help but it doesn't. Happened to me when I 1st took antipsychotics and then when I changed to a new one. Diazepam helped a little.
Hello, Dr. Syl! Could you please comment on Lauren from “Living Well with Schitzophrenia”. She’s been on quite a journey with medical keto. Curious to learn what your opinion is. Thank you! ☺️
Dr Syl, I take a fairly high dose of Pristiq and Valium for anxiety. I have what I feel is tardive dystopia of the mandibular variety.. It seems really minor compared to the extreme cases you have identified in your video, but my jaw is becoming displaced and I am biting my cheek. Being such a mild case, I wonder if it is the SNRI, the benzo or the anxiety. I started by asking my doc to reduce my SNRI med, but it doesn’t seem to be getting better. I go to cognitive therapy every other week. I have been on some form of SSRI or SNRI and benzo for over 20 years… Any thoughts would be appreciated as to next steps.
My husband has MS and he once had an episode where all of his muscles started spasming. His neck, arms, legs, head. Are any of these conditions sometimes found in MS patients? He doesn’t have a history of anti-psychotic medication.
I got clonazepam for being stressed by sitting still, but it makes me fall asleep and bump into things.
Hi ive got akasthesia form abilify 10mg. Its so painful as i have fibromyalgia. Ive just started to reduce to 7.5mg should i go lower please?
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I found one of the best representations of what it’s like to have a delusion. The show is called Black Mirror (season two, episode 2). Episode name: White Bear. There is a huge psychological component to this episode; it can be looked at as a delusion of grandeur or persecution-at least in the untrained eyes of aspiring medical students.
I may be using the terminology wrong.
I know someone (i wont say who bc of the details) who was diagnosed with tartive dysk. They were on an antidepressant; To my knowledge, the duration of time is unknown but definitely under seven years (maybe like 2). Also, this person was in active addiction, using methamphetamines. His symptoms would exacerbate while high. Is it possible all of it was from the illicit drug use, or 100% from the anti depressant? (Again, I'm pretty sure he was on an anti depressant and not an antipsychotic). He had very severe symptoms, sticking his entire tounge out of his mouth, moving his mouth around and also making odd sounds. This same person, also did the other symptom (sorry I already forgot the name) where they cannot sit/stand still, whatsoever. Thank you!
Helloo, idk if you’ve reacted to genesis by ren yet but when you have time can you please listen to it :)
This subject matter always annoys me because of the extent of playing down of side effects over the decades and damage done to people, especially those being put on anti-psychotics off label, which should never happen. Is the doc aware of the AstraZeneca lawsuit over Seroquel? And how the company convinced everyone to off label it, and even after the lawsuit and damage it did to so many it can still be off labelled today, by completely naive GP's. I really hope future doctors and doctors like Syl realise the seriousness of these drugs and the problems they cause, and that they shouldn't be off labelled, especially to kids for non related issues or other mood issues. Even found a psychiatrist from Wollongong on here talking about this and why he does not off label Seroquel anymore, after my GP tried to get me on 100mg dose, because of supposed chronic anxiety which I do not even have and which she often presumes is my main problem.
Not sure if this is akathesia but i find my foot mostly my right one moves up an down when im in bed. Im totally unaware of it until i become aware if that makes sense.
Also i rub the thumb up and down the first joint of my index finger constantly, day and night
Again im not aware im doing it until i notice and when i stop noticing it starts straight up again
From your description this doesn't sound like akathisia. Akathisia is very distressing and affects the whole body, making it impossible to stay still for any length of time meaning no ability to sit sleep or rest. It's common for neurotypical people to do things like bouncing feet and repetitive hand movements just as a habit, but it's especially common for people with ASD/ADHD often as a way to calm ourselves or improve our ability to focus.
What should I react to next?
Here's a link to my upcoming newsletter (use it to follow for updates on my CBT course!): eepurl.com/iMHJp6
th-cam.com/video/tlfvhPVBORY/w-d-xo.html The dissociated woman
Have you spoken about catatonia and treatments. The one time I have seen a severe case on the ward (community mh clinician and visiting a client)and I will never forget the stare. He would still sort of interact but had to be directed to move, lost body function control, stopped eating but you could sort of talk to them. But the what and why and the role of ECT and other treatments.
I would like to see a video on psychogenic polydipsia. I experience this. I also had a lithium toxicity in February where my kidneys almost completely shut down. If there is content enough about that, please make a video!
th-cam.com/video/DjMMV1ab6Ro/w-d-xo.htmlsi=a7vco6FR5fw34GXv
In a world where everything from depression to eating disorders to schizophrenia are being reversed by metabolic interventions, with the ketogenic diet being the strongest lever, it's very hard for me to understand why every person connected with the field of psychiatry is not breaking down doors to learn everything they can about this new approach and to help the people they work with obtain relief.
I had a friend that talked like a Bulldozer (New Yorker) when I jumped in, He would stop vocalizing but his lips would keep mumbling his thought. We would still be friends but he would "fake" punch me in the face & after 2 black eyes I had to move...
21:54 so the needle in the butt and plain mattress on the floor. Or is that just movies an tv
It took you a whole year to do the side effects from 😮
I have a real fear of taking a new drug due to possible side effects. Doctors don't seem to understand and act like I really don't want help.
I have the same!!! And I am missing holistic approach. I also experience some physical problems that I am having herbs for - and the problem is also that I can not take those herbs with antipsychotics and then my general heath declines. On the other hand, without medications i do not function well, I forget meals and spend a lot of money. It is horrible choice - that I have to choose something that hurts my body to be able to nourish it correctly.
thirty-third!!!!
I have experienced some of these symptoms after being forced medicated as a adolescent.
Restless legs syndrome from Mirtazapine, maybe it ain't qualifying for what is explained in the video but terribly annoying nonetheless!
First!!🤭
My late sister had both anerexia and bulemia growing up .
Do you have insight on eating disorders ?
If you're interested I have a song/ video I would like to request
and a two minute ' behind the scenes ' insightful docu. short that has a little more insight beyond the song / video.
It features a famous Norweigan photographer who died from 18 years of anerexia .
The 2 minute short :
' The Self Portrait / AFF 2020 '
Astra Film Festival channel
Susanne Sundfor did the vocals / and worked on the soundtrack
of a documentary about Lene Marie Fossen : ' A self portrait '
The video was skillfully edited from scenes of that documentary .
The song / video is ' When the lord ' Susanne Sundfor
Susanne Sundfor channel .
I’ve been treating bipolar disorder for some years and there are some medications used in it I’ve learned through the years that causes dystonia in me, the tongue symptoms as well as the head as if there’s pressure or a magnet on and inside them. Like a heavy anchor pulling inside the head snd mouth. The antipsychotics ones such as risperidone, ziprasidone(this one is harder than the others) quetiapine and topiramate. I still take risperidone, in a very low dosage but i also take biperiden as an antidote because it’s random if I have a side effect or not. In doubt I take it. Those symptoms are awful to endure, work study and live with.
That’s one of the few videos about it I came across a few years ago
th-cam.com/video/rqhhYnYoOZo/w-d-xo.htmlsi=rzfPvPcHBSEPD6ft
❤ Thank you! I had a bad reaction while hospitalized for intractable migraine. I was given a fast IV push of Reglan. I had taken it orally before with no reaction. That day, the nurse quickly pushed directly into my IV. I had akathisia and a panic attack. I ripped the IV out and left the hospital in my gown. It was a taste of what others go through when living with these sort of symptoms. Rough. 🫠 Don’t administer this way!
When I got reglan in the ER, they gave me an IV push of benadryl 10 minutes before administering it to make me drowsy and cut down on the negative side effects. Definitely made it better!
Got a severe case of TD (whole body and face, really big movements), some days I couldn't even walk. It started 3 months after I began the medication (SSRI 🥲), so I didn't initially make the connection, and lasted a couple of months after coming off - now I have a tic disorder, I think an FND type thing, when stressed or when I see someone with tourettes or something, this video may set me off for a couple of weeks. Thankfully, it's not as bad as the TD.
I remember being upset about the facial movements which lasted well after the body movements stopped. I was scowling, grimacing and sneering alot, and I was worried it would last forever and I wouldn't be able to get a job or work because I couldn't contol my face.
I was on valium for a little bit too, which didn't help with the movements but at least I was relaxed about it.
I had dystonia from taking latuda and rexulti. I couldn’t put my tongue back in my mouth and it was so uncomfortable and scary. They gave me benztropine in the emergency room and it went away quickly. I’ve taken other antipsychotics that didn’t cause dystonia, but a lot of them caused weight gain. I’m on lybalvi now and that has been weight neutral and hasn’t caused dystonia.