How do you address akathisia for patients who have had otherwise an excellent response to their antipsychotic treatment?

Try lowering the dosage of the antipsychotic, if possible. If this is not effective and the patient is on a high-potency FGA medication, try switching to a lower-potency antipsychotic. If the above is not possible, suggest treatment with propranolol (if there is no contraindication) at 10 mg twice d...

I prefer atenolol over propranolol since atenolol doesn't cross the blood-brain barrier and causes "the blahs" which happens too frequently with propranolol.

I start with propranolol 20 mg 2-3 times a day as needed. I instruct them to start with twice a day and to add the midday dose if they need it. Also if it makes them dizzy, break it in half and take a lower dose. Propranolol is not very good at lowering arterial blood pressure which is why I like it...

I agree with Dr. @Dr. First Last. In an acute setting, can also give diphenhydramine (25 to 50 mg IV) or benztropine (1 to 2 mg IV). If this is effective, these medications are given in the PO form for 2-3 days following.

Consider reading this new meta-analysis published in March 2024 and utilizing high-dose Vitamin B6 (Gerolymos et al., PMID 38451521).

First, seek the lowest dose of antipsychotic that is still efficacious. Consider switching to an antipsychotic with lower risk of akathisia.

Failing that, I have found amantadine useful. It’s less anticholinergic than Benadryl or Cogentin, and doesn’t have the “buzz” Cogentin can cause.

It also is n...

"Reduce the dose, reduce the dose, reduce the dose" has worked 90% of the time.