Akathisia vs. Tardive Dyskinesia: What Are the Differences?

Tardive dyskinesia and akathisia are movement disorders that occur as side effects of certain medications, especially medications that are used to treat psychiatric disorders.

Movement disorders are medical conditions that cause recurrent involuntary (not on purpose) movements without causing changes in consciousness. They are caused by problems with chemical regulation in certain areas of the brain. Parkinson’s disease is the best-known movement disorder.

If you are having new involuntary movements or a sense of restlessness, it’s important that you make an appointment to see your neurologist or psychiatrist so you can work together to plan a management strategy that’s right for you.

This article will discuss the similarities and differences in the symptoms, causes, diagnosis, and treatment of tardive dyskinesia and akathisia.

What Are Tardive Dyskinesia and Akathisia? 

Tardive dyskinesia and akathisia are medication side effects. These conditions have some similarities, but they also have differences.

In some medical literature, tardive dyskinesia has been defined as a type of akathisia. And there is also a condition called tardive akathisia. 

There are some consistent features that distinguish these two movement disorders, such as: 

• Tardive dyskinesia: This condition is characterized by brief, twisting movements of the face, mouth, fingers, or extremities. 
• Akathisia: This is described as a type of inner restlessness, described as psychomotor agitation. If you are experiencing akathisia, you may be compelled to move excessively and without a purpose. Movements include rocking back and forth, pacing, or repetitively making a fist. 

You can have both tardive dyskinesia and akathisia, and sometimes one side effect begins months before the other.

What Symptoms Occur with Akathisia and Tardive Dyskinesia?

Akathisia and tardive dyskinesia can develop within days of starting a causative medication, or the symptoms can begin after you have been taking the medication for months or years. 

The symptoms of akathisia and tardive dyskinesia can resemble those of other movement disorders or psychological conditions. 

Most people who have akathisia are aware of the symptoms. Sometimes people who have tardive dyskinesia are aware of the symptoms, but they are not as distressing as the symptoms of akathisia.

Tardive Dyskinesia 

Tardive dyskinesia can involve slow and unusual movements. For example, your mouth may pucker or twist, you might make writhing finger movements, or you may stick out your tongue or tightly shut your eyes.

The movements can resemble tics such as those experienced with the neurological disorder Tourette’s syndrome. Generally, the motor effects of tics with Tourette’s syndrome occur fast and can be jerky, while the movements of tardive dyskinesia are slower, winding, or smooth.

Akathisia 

Akathisia usually involves a sense of internal restlessness. It feels distressing, and the movements do not relieve the feelings of distress. Some people who have akathisia can experience severe unease as a result of this condition, and it is associated with thoughts of suicide.

It can appear like anxiety or tension, but anxiety and tension are usually associated with emotions about stress or a life event, while akathisia is an internal agitation that isn’t provoked by external issues or stress. 

What Causes Akathisia and Tardive Dyskinesia?

Akathisia and tardive dyskinesia are considered medication side effects. Sometimes psychomotor agitation can occur due to severe metabolic changes, delirium (altered mental function), or head trauma, and this has been defined as akathisia in some instances. 

Akathisia and tardive dyskinesia usually occur due to exposure to dopamine blocking agents. Dopamine is a neurotransmitter that aids in many functions of the brain and the body, including movement, motivation, and more.

Disruptions in dopamine action play a role in schizophrenia and other psychiatric conditions, and the medications used to treat these conditions block dopamine action. Movement disorders like Parkinson’s disease are often associated with insufficient dopamine activity.

Different movement disorders can occur when medications that release or involve dopamine affect areas of the brain that control physical movement. The disruption that occurs can lead to side effects of tardive dyskinesia, akathisia, or Parkinsonism (medication-induced symptoms of Parkinson’s disease).

Sometimes medications used to treat mood disorders or gastrointestinal disorders can cause akathisia or tardive dyskinesia.

It isn’t possible to predict whether a person will have one or more of these side effects, how severe the motor side effects will be, or how long they will last.

How Are Akathisia and Tardive Dyskinesia Diagnosed?

If you are taking medications that can cause tardive dyskinesia or akathisia, your healthcare provider will ask you about these symptoms when you go for your regular medical visits or therapy sessions. They will also observe you for signs of the movements during your visit. 

There are no laboratory or imaging tests that can verify these conditions. Your healthcare provider will rely on your medical history and physical examination to diagnose your condition.

Your healthcare provider will use your medical history and physical examination to differentiate between these movement disorders, which is important because they respond differently to treatment.

For example, anticholinergic treatment can worsen tardive dyskinesia, may have a moderately beneficial effect on akathisia, and may help improve symptoms of Parkinsonism.

If you have akathisia or tardive dyskinesia, your healthcare provider will usually document your symptom frequency, which areas of the body are affected, and how severe the symptoms are. Some providers may use a rating scale to quantify your symptoms and to be able to objectively follow the progression or improvement over time. 

Examples of rating scales:

• Abnormal Involuntary Movement Scale (AIMS): This numerical scale can be used to assess tardive dyskinesia and it includes a physical examination, assessment of physical movements, patient awareness of symptoms, and dental status. 
• Barnes Akathisia Rating Scale (BARS): This scale can be used to assess the severity of akathisia and it includes subjective symptoms, objective symptoms, a rating of overall distress, and a measure of the patient’s awareness of the symptoms.

Can You Treat Akathisia and Tardive Dyskinesia?

There are different ways of managing tardive dyskinesia and akathisia. Interventions include replacing the causative medication or reducing the dose, or taking prescription medication that’s used to treat the movement problems.

Counseling, exercise, or physical therapy may be recommended to help you cope with the distress caused by the symptoms.

Medications approved for the treatment of tardive dyskinesia include Austedo (deutetrabenazine) and Ingrezza (valbenazine), which are reversible VMAT2 inhibitors that have an effect on dopamine action.

Sometimes, medications are prescribed off-label to treat the symptoms of tardive dyskinesia or akathisia. Off-label means they have not been approved for treating the condition in question but are approved to treat other conditions.

Examples of off-label treatments include:

• Medications that have been used to treat tardive dyskinesia include antianxiety medications and anti-seizure medications.
• Medications that have been used to treat akathisia include Inderal (propranolol), Lopressor (metoprolol), anticholinergics, tricyclic antidepressants, benzodiazepines (drugs that calm or sedate you), and Periactin (cyproheptadine).

If you experience any signs of akathisia or tardive dyskinesia, it’s important to discuss the management plan with your healthcare provider rather than trying to manage it on your own.

The underlying conditions that the medications are used to treat can have serious consequences, and these side effects can be distressing for some people, especially if they are not adequately managed. 

How Can I Prevent Akathisia and Tardive Dyskinesia?

Generally, it’s best to use antipsychotic medications and other medications that can cause tardive dyskinesia or akathisia at the lowest effective dose. You may be prescribed a low starting dose with a gradually scheduled increase over time. 

If you start to experience side effects before the target dose is reached or at a dose that is not effective for controlling your symptoms, your psychiatrist might switch you to a different medication. Maintaining communication is an important part of preventing tardive dyskinesia and akathisia. 

How Talk to Your Healthcare Provider

Ask your psychiatrist or pharmacist about the potential side effects of the medications that you are taking. Make sure you call your healthcare provider or make an appointment if you begin to experience signs of side effects.

Summary

Tardive dyskinesia and akathisia are movement disorders that can develop as medication side effects. These side effects have been recognized for as long as antipsychotic medications have been in use. They can also occur due to other medications used to treat gastrointestinal disorders or mood disorders.

Tardive dyskinesia usually involves involuntary repetitive movements of the face, mouth, fingers, or arms. Akathisia is an internal sense of restlessness, which may result in movement such as rocking back and forth or excessive pacing. They can occur alone or together, and they might not begin at the same time when they occur together.

Treatment can involve a combination of adjusting the causative medication, therapy to help cope with the condition, and medication to help reduce the symptoms.

A Word From Verywell 

Akathisia and tardive dyskinesia can be difficult to cope with if you or a loved one has been diagnosed with either of these conditions, it can take time for treatment to be effective. In the meantime, it can help to reach out to a therapist to get support and to discuss your concerns and the feelings that you are having about your movement problems.