Akathisia is most commonly associated with use of which medication class?

• A. Antidepressants
• B. Antipsychotics
• C. Anticonvulsants
• D. Anxiolytics

Answer: (B)

Akathisia is an inner sense of restlessness with an urge to move, an extrapyramidal symptom caused by blocking dopamine D2 receptors in the nigrostriatal pathway. This pharmacologic effect is most strongly linked to antipsychotic medications, especially high-potency typical antipsychotics like haloperidol and fluphenazine, which produce strong D2 blockade and therefore a higher risk of akathisia. It typically appears within days to weeks after starting treatment or increasing the dose. While antidepressants can occasionally cause restlessness, the classic and most frequent association is with antipsychotics. In practice, management focuses on adjusting the antipsychotic regimen or adding symptomatic treatments such as propranolol or a benzodiazepine as needed.