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Bipolar Symptoms: Psychomotor Agitation

A reader recently contacted me and asked me about psychomotor agitation. Psychomotor agitation is actually a symptom of bipolar hypomania and bipolar mania (and depression) and yet few people know what this means. In fact, according to this study, it is poorly defined and measured even within the medical community. Psychomotor agitation is often translated into “restlessness,” which doesn’t seem overly descriptive to me.

So here’s my take on psychomotor agitation: how it feels and what we know about it.

Definition of Psychomotor Agitation

Wikipedia defines psychomotor agitation as:

. . . a series of unintentional and purposeless motions that stem from mental tension and anxiety of an individual. This includes pacing around a room, wringing one’s hands, pulling off clothing and putting it back on and other similar actions.

I would not consider this to be the best definition, however. While unintentional and purposeless motion may come as a result of psychomotor agitation, they, alone, do not define the condition.

A slightly better definition comes from Reference.MD:

A feeling of restlessness associated with increased motor activity. This may occur as a manifestation of nervous system drug toxicity or other conditions.

In other words psychomotor agitation is the feeling of restlessness (and inner tension) associated with muscle activity.

However, this is contradicted by one study in which psychomotor agitation was considered present if:

. . . fidgeting, pacing, handwringing, and/or other purposeless movements were evident nearly every day for at least a 2-week period leading up to the assessment. PMA [psychomotor agitation]-related behaviors had to be noticed by others and/or directly observable during the interview.

So in this case, the inner feelings seem not to be taken into account.

(Psychomotor agitation, by the way, has been correlated with substance abuse as well as bipolar disorder. Additionally, some feel that psychomotor agitation with depression is a key marker of a depressive mixed state.)

The Problem with Psychomotor Agitation

Certainly the repetitive, unintentional, purposeless movements associated with this condition are an issue, but what I think bothers people most is the inner feeling associated with it. It’s the drive to make the purposeless movements that makes this symptom intolerable. It’s the inner feeling of restlessness, tension and anxiety that really makes people hate this symptom.

It’s very difficult to describe tension that is so extreme that it forces movement, but this is what happens. It’s more than bugs crawling under your skin that you wish to scratch out with your fingernails. It’s like under-skin crawling bugs that are so agitating that they require arm flailing in an (unsuccessful) attempt to rid yourself of the feeling.

Treating Psychomotor Agitation

As far as I can tell, there are no generally used treatments for psychomotor agitation unless the situation is very severe or an emergency – such as in the case where the patient endangers themselves or others with their movements. In these cases, opinions vary on what to do but non-pharmacological interventions seem preferred.

If I had to advise someone on what to do about psychomotor agitation what I would suggest is the same kind of techniques that are advised for anxiety such as yoga, meditation and other relaxation techniques. But that’s just me.

What I suspect is more common is that psychomotor agitation is reduced when the medication for bipolar disorder (or depression) takes effect.

You can find Natasha Tracy on Facebook or GooglePlus or @Natasha_Tracy on Twitter or at the Bipolar Burble, her blog.

Author: Natasha Tracy

Natasha Tracy is a renowned speaker, award-winning advocate and author of Lost Marbles: Insights into My Life with Depression & Bipolar.

Find Natasha Tracy on her blog, Bipolar Burble, Twitter, Google+ and Facebook.

62 thoughts on “Bipolar Symptoms: Psychomotor Agitation”

  1. My son was diagnosed with Bipolar and recently I saw him and he seemed quite agitated. How do you know if he is taking his meds

    1. Hi Susan,

      I’m sorry, there is no easy way to tell that. The only way people typically know is if they know the person intimately both before and after medication. The only way to know for sure is to ask.

      – Natasha Tracy

  2. My symptoms have been so severe, the psychomotor agitation, screaming in my head, general unrest, I feel like I’m going out of my mind. I just want it to stop. It’s been a count down to my pdoc: tomorrow finally! It’s like my pmeds just aren’t working anymore. And no, I don’t take other drugs and don’t drink.

  3. Spring sprang early this year and I feel I’m so agitated and about to come undone. Thank God I am not flailing physically. There’s something to be thankful for. But the way I’m feeling mentally is horrid. It feels like I’m on the edge of full blown, take-me-to-the-hospital now. I tried to get off of 50mg of Seroquel and change to Latuda. After not sleeping well for three weeks, we went back to Seroquel. I’m sleeping 10 hours a night, but during the day I begin to have this severe psychomotor agitation until I take the med again at 6:30 p.m. when it begins to subside. Do I need to go up in dose or wait this out. Desperate. Thanks for any comments.

  4. The symptoms you describe, i.e., internal agitation and restlelessness bear the hallmarks of akasthisia – a drug-induced condition which is notoriously difficult to treat. This condition is caused by antipsychotics and a whole range of psychotropic medications. Even a change in dose and/or a change in medication can induce it. Confusing akasthisia with bipolar is common.

  5. I have been looking for answers to this as well. I started getting these what I called twitches in September of 2015. It started with a stomp to the floor and the occasional arm jumping. I saw a GP for it and she decided to put me on Anti-Depressants to try and help. I went through a really stressful time with my PTSD brother who came to live with us in February. I somehow took on his stress from his anger and delusions etc. I knew nothing about mental health issues and was ignorant like the rest of the masses. During his being here, my jumping got alot worse, I could not find relief from it. I started not sleeping very well and then my judgement got foggy, and I felt so energized. I was talking weird, and using words I had picked up from my brother during his delusions. I somehow started taking them on as my own. I had never heard of the word “Muggle” but now felt like it applied to everyone around me who I deemed inferior. I insulted my boss, and a girl claimed I sexually harassed her. I don’t think I did, but who’s to know…I lost alot of memory chunks during all this. Ultimately this issue with acting out of my head, jumping around twitching like a madman got me fired from a well paying job that cost the wife and I our house. I finally went to the doctor who referred me to a psychiatrist. I was not seen at first, it took months to get me in…once in they saw me, and said right away I was BiPolar1. Now, I went my whole life, 38 years worth of never being manic. I had been through depression like a MOFO at a time or two in life. I got my diagnosis and I got meds. However the jumps and tics seem to come just a frequent as before mania took over. I have been out of mania since August or so of 2016. I sometimes feel the jumps coming, but it is rare. However even knowing its coming offers little to help, the jump just comes out elsewhere. I am tired of feeling like a fool in public. I stomp my feet, my arms might flail around. Sometimes it even creates a speech like tic. I will utter some nonsense in those times, just like 2 syllables. I have never been a big drinker, or drug user except this year during mania, but this was happening before that. Any suggestions on where to research more, offer advice etc? My therapist says she thinks the meds will fix it, but never says or seems to know anything about what drives it. I do know if I am suddenly upset or have a bad thought, remembering this past year for example makes me jump.

    Before anyone asks, I take:
    Depakote 1000mg
    Lamictal 200mg.


  6. Hi, I get this at least once a year.
    I have not been diagnosed with bipolar, more like bpd/eupd with bipolar traits… I had no idea this was part of bipolar, I’ve been like this for years :/
    Is this symptom specific to bipolar? Or could it be related to something else?

  7. Hi, I was diagnosed with bipolar when I was a teen. They said my bipolar was the kind where your moods change very quickly. I was on medication til I was 19 and then I went cold turkey. I hated the way it made me feel. I felt like I had no personality kind of like a zombie. My mom was there for me while I was cold turkey. Everything was fine for a few years but here I am now at the age of 24 and I feel like I’m losing control of myself. I’m having a fit every other day out of irritation and anxiety. I also have OCD but I think that that has gotten out of control too. Everything has to be exact and in its place or I become overwhelmed with frustration and I start scratching my skin and pulling my eyelashes and hair from my scalp. I never used to be like this before during and after my use of bipolar meds. I’m honestly worried about myself and what’s happening to me. Can somebody please help me understand what is going on? I’ve thought about yoga because people say it helps calm the inner body and thoughts. But I def don’t want to go on bipolar meds again if I can avoid it.

  8. I’ve never been diagnosed with any full fledged disorder. At my last evaluation i lied to the therapist ALOT and they said i have an adjustment disorder or something of that nature. But sometimes when my emotions become so extreme that i have these fits. It may be sadness one day or rage the next. But the rage is the scariest part. I get this feeling in the bottom of my stomach like someone set a fire and my whole body gets hot and i just snap. I punched a hole in my wall last week and i can’t even remember why i was so mad. I’ll be laying down relaxing and just feel a wave of rage come over me. I just don’t know what to do.

  9. hello, i have bipolar was diagnosed as a young teen, I find i am having a difficult time with the symptoms as of recently. i frequently swing between fits of uncontrolled rage and agitation to feelings of dread and not wanting to get out of bed and see light of day. I think the worst is the i dont care about anything faze for me though. as far as his recent blog, i typed in sypmtoms i was having that i hadnt been having before. The itchy feeling like something is biting me all over my body, restlessness my arms and legs just kicking and flailing out mostly at night when i am trying to lay down, for the last 2 weeks i have gotten an hour or 2 sleep a night and find i am so exhausted i can barely move sometimes. Thank you for putting a name to my most recent issue, hopefull with the Doctors help i can get it managable, i am already taking so many different meds to treat my bipolar i really hate adding more but even my eye wont stop twitching.

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