Anxiety And Akathisia

Written by Jim Folk
Medically reviewed by Marilyn Folk, BScN.
Last updated April 30, 2022

anxiety and akathisia symptoms

Akathisia (can’t remain still, restlessness, agitation, nervous energy) is a common anxiety disorder symptom, including anxiety and panic attacks, generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, phobias, and others.

This article explains the relationship between anxiety and akathisia symptoms.

Common Akathisia Anxiety Symptom Descriptions

  • You have so much energy that you feel you can’t remain still.
  • You have to be constantly moving because of how energized your body feels.
  • You are constantly fidgeting because you feel you have too much nervous energy.
  • Your body feels wired with “nervous energy” and feels like it wants you to keep moving (especially the lower extremities).
  • You also feel that even slowing down for a moment is difficult.
  • When you want to relax and rest, you can’t because your body and mind are so wound up.
  • The energy you feel is so strong that you are constantly tapping your fingers or feet, twiddling your thumbs, shifting or shuffling in your chair, or moving your legs.
  • The energy that you feel is so strong that you can’t even stand still without feeling like you have to pace, shuffle your feet, or shift your body every moment or so.
  • The energy you feel is so strong that you have difficulty containing your fidgeting.
  • When trying to rest, you have to constantly move your legs because the urge to move becomes so strong.
  • The inner restlessness is so strong that you feel constantly compelled to move.
  • At times the nervous energy feels good and stimulating, while at other times, it feels relentless and draining. Some people even feel physically sick because their bodies are so geared up and resistant to calm down and remain still.

This symptom can:

  • Occur occasionally, frequently, or persistently.
  • Precede, accompany, or follow an escalation of other anxiety symptoms or occur by itself.
  • Precede, accompany, or follow a period of nervousness, anxiety, fear, and stress, or occur "out of the blue" and for no reason.
  • Range in intensity from slight, to moderate, to severe.
  • Come in waves where it’s strong one moment and eases off the next.
  • Change from day to day, moment to moment, or remain as a constant background during your struggle with anxiety disorder.

All combinations and variations of the above are common.

This nervous energy symptom can seem more bothersome when undistracted, resting, doing deep relaxation, or when trying to go to sleep or when waking up. In fact, it can be so problematic that it can interfere with resting, deep relaxation, and sleep…and to the point of impairing them.

To see if anxiety might be playing a role in your symptoms, rate your level of anxiety using our free one-minute instant results Anxiety Test, Anxiety Disorder Test, or Hyperstimulation Test.

The higher the rating, the more likely anxiety could be contributing to or causing your anxiety symptoms, including feeling like impending doom symptoms.

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Causes

Medical Advisory

Talk to your doctor about all new, changing, persistent, and returning symptoms as some medical conditions and medications can cause anxiety-like symptoms.

Additional Medical Advisory Information.

1. The Stress Response

Anxious behavior, such as worry, activates the stress response. The stress response causes many body-wide changes that prepare the body for immediate emergency action – to fight or flee.

This survival reaction is often referred to as the fight or flight response, the emergency response, the fight, flight, or freeze response (some people freeze when they are afraid, like a “deer caught in headlights”), or the fight, flight, freeze, or faint response (since some people faint when they are afraid).[1][2]

Some of these changes include:

  • Quickly converts the body’s energy reserves into “fuel” (blood sugar) to have an instant boost of energy.
  • Stimulates the body, especially the nervous system (which includes the brain), to detect and react to danger more quickly.
  • Heightens nervous system activity, especially in the amygdala (thought to be the brain’s fear center).
  • Increases metabolism.
  • Increases heart rate.
  • Increases respiration.
  • Heightens most of the body’s senses.

To name a few.

Visit our “Stress Response” article for more information about its many changes.

The higher the degree of stress response, the more dramatic the changes.

All these above changes stimulate the body since stress hormones are powerful stimulants.

Since these changes are supposed to increase energy to either fight or flee, stress responses make you feel energized, including so much so you can’t remain still.

An active stress response is a common cause of feeling like you have so much energy you can’t remain still.

Anxious behavior is a common cause of acute akathisia.

2. Hyperstimulation (chronic stress)

When stress responses occur infrequently, the body quickly recovers from the many stress response changes.

However, when stress responses occur too often, such as from overly anxious behavior, the body can remain in a state of semi-stress response readiness, which we call “stress-response hyperstimulation.”[3][4]

Hyperstimulation is also often referred to as “hyperarousal,” “HPA axis dysfunction,” or “nervous system dysregulation.”[5][6]

Hyperstimulation can keep the body overly stimulated even though you don’t feel anxious or stressed at that moment.

Visit our “Hyperstimulation” article for more information about the many ways hyperstimulation can affect the body and how we feel.

Hyperstimulation is a common cause of chronic akathisia: difficulty remaining still.

As the degree of hyperstimulation increases, so does the likelihood of having issues with restlessness and difficulty remaining still.

Most overly anxious people feel restless due to anxiety and hyperstimulation.

3. Side effects of medication

Many medications, including common psychotropic medications (anti-anxiety, antidepressants, mood stabilizers, etc.) can cause a wide range of side effects when starting them, taking them regularly, missing dosages, switching to another medication, in combination with other medications and over-the-counter medications, and when discontinuing them. Akathisia is a common side effect of psychotropic medications.[7][8]

Talk with your doctor and pharmacist if you believe your medication is causing your akathisia symptoms.

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Other Factors

Other factors can create stress and cause anxiety-like symptoms, as well as aggravate existing anxiety symptoms, including:

Select the relevant link for more information.

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How to stop akathisia anxiety symptoms?

When this symptom is caused or aggravated by other factors, addressing those factors can reduce and eliminate it.

When this symptom is caused by anxious behavior and active stress response, ending the stress response will end its changes. This symptom should subside as your body recovers from the active stress response.

Keep in mind it can take up to 20 minutes or more for the body to recover from a major stress response. But this is normal and shouldn’t be a cause for concern.

When this symptom is caused by hyperstimulation (chronic stress), eliminating hyperstimulation will end this anxiety symptom.

You can eliminate hyperstimulation by:

  • Reducing stress.
  • Containing anxious behavior (since anxiety creates stress).
  • Regular deep relaxation.
  • Avoiding stimulants.
  • Regular light to moderate exercise.
  • Getting regular good sleep.
  • Eating a healthy diet of whole and natural foods.
  • Passively-accepting your symptoms until they subside.
  • Being patient as your body recovers.

Visit our “60 Natural Ways To Reduce Stress” article for more ways to reduce stress.

As the body recovers from hyperstimulation, it stops sending symptoms of hyperstimulation, including feeling like you can’t remain still.

Hyperstimulation symptoms subside as the body regains its normal, non-hyperstimulated health.

However, eliminating hyperstimulation can take much longer than most people think, causing symptoms to linger longer than expected.

As long as the body is even slightly hyperstimulated, it can present symptoms of any type, number, intensity, duration, frequency, and at any time, including this one.

Even so, since akathisia is a common symptom of hyperstimulation, including anxiety-caused hyperstimulation, it's harmless and needn't be a cause for concern. It will subside when you’ve eliminated hyperstimulation and given your body sufficient time to stabilize. Therefore, there is no reason to worry about it.

Anxiety symptoms often linger because:

  • The body is still being stressed (from stressful circumstances or anxious behavior).
  • Your stress hasn't diminished enough or for long enough.
  • Your body hasn't completed its recovery work.

Addressing the reason for lingering symptoms will allow the body to recover.

Most often, lingering anxiety symptoms ONLY remain because of the above reasons. They AREN'T a sign of a medical problem. This is especially true if you have had your symptoms evaluated by your doctor, and they have been solely attributed to anxiety or stress.

Chronic anxiety symptoms subside when hyperstimulation is eliminated. As the body recovers and stabilizes, all chronic anxiety symptoms will slowly diminish and eventually disappear.

Since worrying and becoming upset about anxiety symptoms stress the body, these behaviors can interfere with recovery.

Passively accepting your symptoms – allowing them to persist without reacting to, resisting, worrying about, or fighting them – while doing your recovery work will cause their cessation in time.

Acceptance, practice, and patience are key to recovery.

Since the body can take a long time to recover from hyperstimulation, it's best to faithfully work at your recovery despite the lack of apparent progress.

However, if you persevere with your recovery work, you will succeed.

You also have to do your recovery work FIRST before your body can recover. The cumulative effects of your recovery work will produce results down the road. And the body's stimulation has to diminish before symptoms can subside.

Eliminating hyperstimulation will bring results in time!

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Short-term strategies

Even though eliminating hyperstimulation will eliminate chronic anxiety symptoms, including akathisia, some people have found the following strategies helpful in reducing episodes of this symptom in the short-term.

However, keep in mind that each person can have a unique symptom experience since each person is somewhat physically, chemically, psychologically, and emotionally unique. What might work for one person might not for another.

Reduce stress – Since stress, including anxiety-caused stress, is a common cause of feeling like you can’t remain still, reducing stress can reduce episodes of this symptom.

Any stress reduction strategy can help improve this symptom. Visit our article “60 Ways To Reduce Stress And Anxiety” for natural stress reduction strategies.

Regular good sleep – Regular good sleep can reduce stress, cortisol, and the body’s overall level of stimulation. Their reduction can reduce and eliminate anxiety symptoms, including this one.

Regular deep relaxation – Deep relaxation reduces the body’s overall level of stimulation and stress, leading to a reduction in anxiety symptoms, including restlessness.

Regular light to moderate exercise – Regular light to moderate exercise can reduce stress and use up excess cortisol, which can help reduce anxiety symptoms, including this one.

Avoid stimulants – Stimulants, such as caffeine, bring about their stimulating effect by increasing circulating cortisol, the body’s most powerful stress hormone. To help the body recover from hyperstimulation, we need to reduce the production of stress hormones and stimulation, not increase it. A reduction in stress and stimulation can help reduce symptoms of hyperstimulation, including akathisia symptoms.

Contain your anxiousness – Since anxiety activates the stress response, which causes anxiety and hyperstimulation symptoms, containing your anxiousness about this anxiety symptom can help reduce and eliminate it, even in the short term.

The more successful you are in containing your anxiousness, the more opportunity your body has to reduce stress and stimulation. A reduction in stress and stimulation can reduce episodes of this symptom.

Keep well hydrated – Dehydration can cause anxiety-like symptoms and aggravate existing anxiety symptoms. Keeping your body well hydrated can reduce and eliminate anxiety symptoms, such as this one.

Therapy

Unidentified and unaddressed underlying factors cause issues with anxiety. As such, they are the primary reason why anxiety symptoms persist.[9][10][11]

Addressing your underlying factors (Level Two recovery) is most important if you want lasting success.

Addressing Level Two recovery can help you:

  • Contain anxious behavior.
  • Become unafraid of anxiety symptoms and the strong feelings of anxiety.
  • End anxiety symptoms.
  • Successfully address the underlying factors that so often cause issues with anxiety.
  • End what can feel like out-of-control worry.

All our recommended anxiety therapists have had anxiety disorder and overcame it. Their personal experience with anxiety disorder and their Master's Degree and above professional training gives them insight other therapists don't have.

If you want to achieve lasting success over anxiety disorder, any one of our recommended therapists would be a good choice.

Working with an experienced anxiety disorder therapist is the most effective way to treat anxiety disorder, especially if you have persistent symptoms and difficulty containing anxious behavior, such as worry.

In many cases, working with an experienced therapist is the only way to overcome stubborn anxiety.

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Prevalence

In an online poll we conducted, 93 percent of respondents said they had akathisia anxiety symptoms.

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The combination of good self-help information and working with an experienced anxiety disorder therapist, coach, or counselor is the most effective way to address anxiety and its many symptoms. Until the core causes of anxiety are addressed – which we call the underlying factors of anxiety – a struggle with anxiety unwellness can return again and again. Dealing with the underlying factors of anxiety is the best way to address problematic anxiety.

Additional Resources

Return to our anxiety disorders signs and symptoms page.

anxietycentre.com: Information, support, and therapy for anxiety disorder and its symptoms, including akathisia anxiety symptoms.

References

1. Folk, Jim, and Liashko, Vitaly. “The Stress Response.” anxietycentre.com, April 2022.

2. Godoy, Livea, et al. "A Comprehensive Overview on Stress Neurobiology: Basic Concepts and Clinical Implications." Frontiers In Behavioral Neuroscience, 3, July 2018.

3. Teixeira, Renata Roland, et al. “Chronic Stress Induces a Hyporeactivity of the Autonomic Nervous System in Response to Acute Mental Stressor and Impairs Cognitive Performance in Business Executives.” Current Neurology and Neuroscience Reports., U.S. National Library of Medicine, 2015.

4. Yaribeygi, Habib, et al. “The Impact of Stress on Body Function: A Review.” EXCLI Journal, Leibniz Research Centre for Working Environment and Human Factors, 2017.

5. Kinlein, Scott A., et al. “Dysregulated Hypothalamic–Pituitary–Adrenal Axis Function Contributes to Altered Endocrine and Neurobehavioral Responses to Acute Stress.” Frontiers In Psychiatry, 13 Mar. 2015.

6. Chang, L. et al. “Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis in irritable bowel syndrome.” Center for Neurobiology of Stress, 22 Jan. 2009.

7. Patel, Jason, and Marwaha, Raman. "Akathisia." National Library of Medicine, 7 Feb 2022.

8. Pringsheim, Tamara, et al. "The Assessment and Treatment of Antipsychotic-Induced Akathisia." The Canadian Journal Of Psychiatry, Nov 2018.

9. Hofmann, Stefan G., et al. “The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-Analyses.” Cognitive Therapy and Research, U.S. National Library of Medicine, 1 Oct. 2012.

10. Leichsenring, Falk. “Is Cognitive Behavioral Therapy the Gold Standard for Psychotherapy?” JAMA, American Medical Association, 10 Oct. 2017.

11. DISCLAIMER: Because each body is somewhat chemically unique, and because each person will have a unique mix of symptoms and underlying factors, recovery results may vary. Variances can occur for many reasons, including due to the severity of the condition, the ability of the person to apply the recovery concepts, and the commitment to making behavioral change.