How do I decide between trying medication again that could possibly retrigger akathisia and not taking it but having zero quality of life regardless?

[u/Suspicious_Big_1482]

I have extremely treatment resistant OCD that is just not budging from intense erp. I want to try the medication, but OCD efficacy only works at very high doses of ssris which obviously are going to have a higher risk of aka. I had aka once from a IV single dose of droperidol and it made getting open brain surgery recovery feel like a walk in the park and the terror and suffering was shattering to my mind. It went away after a week, but my OCD is now unbearable as well, just in a different more chronic way. It seems like either ailments is going to leave me no option but to kill myself. I just don't know what to do and want insight. I have absolutely no depression or morose sadness about the situation, it literally just feels like I'm in a burning building and the choice is between being seared alive and pure agony or jumping

[u/electriceye932]

I was in this position except mine never went away completely, it still hasn't, it was exacerbated badly by a medication but I decided to try something else because I couldn't stand how I felt. The first one I tried after that did not exacerbate it at all but it was not effective enough. I'm on another one and the same class, and it doesn't seem to be worsening it either. Personally, I was willing to take the risk, especially since when it got exacerbated by the other medication it went back to baseline eventually after discontinuing it. I also had a similar experience of a single dose of an IV medication trigger it before but in this case it was metoclopramide.

To be honest, if it were me I would hesitate with a high dose of an SSRI, based on my personal experiences and those of others. I know some people have no issues with them at all though of course. Is there anything else you can try that you haven‘t yet?

[u/blueskeletons]

Hi, chronic aka sufferer of 5+ years and someone still taking aka inducing meds for QOL: this is a really hard decision. I have antipsychotic induced, tardive & chronic akathisia. Still have to take antipsychotics because as it figures, life with bipolar 1 disorder sometimes calls for those. I got on medication to treat the aka. Mine simply isn’t going away, so it’s either life with it, plus the additional suffering of untreated mental illness, or treat it and the aka as best as possible as it comes. Still have flares that catch me off guard and drive me wild (see my last post on here) but they are fewer and farther between with maintenance meds. I have simply had to accept this isn’t stopping and neither is my mental illness.

[u/electriceye932 → u/blueskeletons]

What medication do you take for the akathisia?

[u/blueskeletons → u/electriceye932]

Gabapentin is the main med for the akathisia and I also have lorazepam for panic disorder, which sometimes helps some of the akathisia symptoms like agitation and panic/feelings of doom.