What Is Psychomotor Agitation? How Is It Caused and Treated?

Psychomotor agitation is a common symptom of bipolar disorder

close up of nervous person's hands
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Psychomotor agitation is an increase in purposeless physical activity often associated with depression and mania. Symptoms may take the form of restlessness, pacing, tapping fingers or feet, abruptly starting and stopping tasks, rapid talking, racing thoughts and ideas, meaninglessly moving objects around, and more.

What Causes Psychomotor Agitation?

While the condition is not well understood, most experts believe that psychomotor agitation is caused by mental tension that cannot be managed in typical ways -- through relaxation methods, exercise, or cognitive therapy.

Conditions associated with psychomotor agitation, in addition to bipolar disorder, include:

  • Post-traumatic stress disorder (PTSD)
  • Panic attacks
  • Anxiety disorder
  • Alcohol withdrawal
  • Claustrophobia
  • Parkinson's Disease 
  • Traumatic Brain Injury (TBI)
  • Dementia
  • Certain psychoactive drugs can, in some cases, cause psychomotor agitation

How Is Psychomotor Agitation Related to Bipolar Disorder?

Manic Episodes.  Psychomotor agitation may occur during manic episodes, in conjunction with racing thoughts or "flight of ideas." Thoughts and emotions become so overwhelming that they literally overflow into physical motion. Unfortunately, actions like pacing, hand-wringing, tapping, and so forth have no useful outcome: they neither lessen anxiety nor do they help to stabilize mood.

Mixed Affective State. During mixed affective episodes, people with bipolar disorder experience both depression and the anxiety and agitation that come with mania.

As a result, they may be irritable, emotionally fragile, and prone to psychomotor agitation. Mixed affective state can be very difficult to manage, and psychomotor agitation may be an attempt to use physical movement to calm nerves.

Agitated Depression. is frequently, though not exclusively, associated with psychomotor agitation.

Similar to mixed affective state, people with agitated depression are coping not only with the challenges of severe depression but also with high anxiety, restlessness, and agitation.  In some cases, agitated depression may actually be caused by medications used to stabilize mood.

Treating Psychomotor Agitation in Bipolar  Disorder

Because psychomotor agitation may be caused by a wide range of issues, it is always important to thoroughly explore possible causes before prescribing medication. In some cases, medication for depression can actually cause extreme anxiety, leading to psychomotor agitation and, in some cases, suicidal thoughts or actions. In other cases, injury, infection, nutritional deficiencies, or other issues unrelated to bipolar disorder may be causing severe distress.  

Once other issues are ruled out, treatment involves lessening anxiety in order to control symptoms. In order to quickly address and manage psychomotor agitation, practitioners first turn to medication.  Medications such as anticonvulsants or anti-manic mood stabilizers (such as Lithium) may be helpful when psychomotor agitation occurs during a manic phase.

 Antipsychotic medications may help when the problem arises during a depressive episode. Anti-anxiety medications such as benzodiazepines may help to manage generalized anxiety. 

After medication is effective in stabilizing mood, cognitive (talk) therapy may be helpful in managing anxiety. Other techniques include meditation, exercise, yoga, and other proven methods of relaxation.

More Information:

Sources:

Benazzi, Franco. ,Psychomotor changes in melancholic and atypical depression: unipolar and bipolar-II subtypes. Psychiatry Research Volume 112, Issue 3, 15 November 2002, Pages 211–220.

Piguet C et al. Phenomenology of racing and crowded thoughts in mood disorders: a theoretical reappraisal. Journal of Affective Disorders. 2010 Mar;121(3):189-98.

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