I totally understand you, fearing akathisia and TD and especially given that TD can be irreversible. I was the same way as you, fearing Abilify especially given the very high % of akathisia side effects in its clinical trials. And because I had experienced terrible akathisia even on APs that normally do not cause it, esp. Seroquel at high doses, I was resistant to trying Abilify.

Ultimately I tried it and it did NOT cause akathisia. It caused nausea and nausea would not go away. I did not have Zofran at that time. Nausea was very bad and would not go away, so I ultimately stopped Abilify. Now if I had to try Abilify again, I would pair it with Zofran to counteract nausea and push through, but I do not need that trial now because ultimately a combo of Geodon and Seroquel for sleep, with occasional Lybalvi PRN, works just fine for me. The point it, it is only through trial and error that you learn how any medication acts in your unique body, so do not be afraid, try and if it does not work, desist from using it.

A couple of things in general in terms of counteracting akathisia:

- Gabapentin ameliorates akathisia and has other positive effects including the improvement of sleep architecture
- High doses of Vit B6 (300 mg and more but not much more) coupled with a regular B complex ameliorate EPS in general. My psychiatrist researched the issue, I started taking B vitamins last year, and virtually all EPS are gone. Take it from me as someone very prone to EPS, akathisia, and Parkinsonism.

In general, for TD prevention, aim to use the lowest dose of AP that works in you. The lower the dose, the lesser the risk of TD.

And, you are not going to get TD from just trying. It is safe to try and if you do not like it, you can stop and seek another agent.

As for QT-interval prolongation, it is a possible side effect of all APs. Get a baseline EKG before you go on Abilify and then follow up with regular EKGs for monitoring. If you catch QT-interval prolongation, stop Abilify and seek another agent.