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
. . . 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.
Tracy, N. (2013, May 9). Bipolar Symptoms: Psychomotor Agitation, HealthyPlace. Retrieved on 2019, June 16 from https://www.healthyplace.com/blogs/breakingbipolar/2013/05/bipolar-symptoms-psychomotor-agitation
Author: Natasha Tracy
So i read this article and a lot of comments detailing more personal takes on this. I was lead to this through a search trying to figure out if these types of tweaks/twitches I have were perhaps a symptoms of high functioning autism or something. But in finding this article, having been diagnosed as bipolar, and being high on weed a lot, it made sense that this would apply to me. However, it seems like most of you almost experince it negatively? And in a more random way than me. Is it possible for this to feel nice? Joyful even. For me, it'd always the exact same motions, it's usually due to a burst of overwhelming excitement that manifests in a physical reaction--usually to have my hands fly to my face where i usually tap my fingertips gently but excitedly on my forehead, my face contorted in an extreme look of joy. In that moment, I usually hold my breath and it feels uncontrollable but I also somehow know to never do it in front of anyone....?/I ususlly only get high alone. But can't remember doing it around others when high either. It feels almost like orgasms diiiistant cousin, the very quick, satisfying release of abundant joy. Any ideas if this is the same thing or something else?
My husband has bipolar disorder and has lived with the diagnosis and all of its troubling symptoms for over 20 years now. It's been our experience that psychomotor agitation is directly related to psychiatric medications. For him specifically it is a side effect of antidepressants. It is also accompanied by a tremor. A decreased dosage usually alleviates the problem. Other psychiatric meds have just as debilitating side effects. Antipsychotics for instance give him such a severe case of akathisia that he literally can't sit still for more than 30 seconds. Everyone is different, thus side effects are different for every drug as well. Different drugs within the same class will also emit different side effects. He lived with psychomotor agitation and debilitating tremors for 20 years because he didn't believe he had a choice. It was either take the meds or risk an episode resulting in hospitalization. He no longer suffers because he now has a psychiatrist who listens and is willing to work with him to find the right combination of medications at the right dosage for him. He was a victim of his condition for too long believing that he had no control. With a collaborative Doctor he now understands he doesn't have to suffer and still maintain control of this disorder. There are options out there. It's finding the right one for you!
This is a great question and I wish a doctor would answer it for you (and me). It seems that akathisia is seen in the side effect world while psychomotor agitation is seen in the symptom world so the difference may simply be that one is intrinsic to a disease while the other is a side effect because the definitions for both are extremely similar.
- Natasha Tracy
I can't say what is happening for you, specifically, but I can say that steroids _can_ affect your mental health. If you are hurting yourself or are too distressed, you should definitely contact a doctor as he or she likely can help.
- Natasha Tracy
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
Before anyone asks, I take:
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?
I would suggest that getting this on a yearly basis is likely not part of bipolar, but you need to contact a healthcare professional to make sure.
- Natasha Tracy
(feel) it in a muffled sort of way. It is so distracting that I have to hear or see other things over and over again to get the whole message. I liken it to having the preverbal angel on one shoulder and the devil on the other, except neither is good or evil, just opposite. Like a constant debate that has no particular subject matter and never ends until I am asleep. I take medication for depression and am now weening off one and onto another because my doctor feels I have been on this one medication too long. Every time I go through a dosage change / adjustment, or a change of drug, I go through this up and down rollercoaster ride until it stabilizes again. Usually about three months or so of absolute torture. I am not violent, or particularly sad, but I am so empathic that I can literally feel what others around me are feeling. I can not tell you how intrusive it is to have to feel not only one other persons emotions but those of everyone who is around you. I often isolate myself to be free of this constantly intrusive emotional onslaught from all around me. I used to be able to be passionate, but now I have to hold back and avoid extreme states of emotion and passion, lest I become a lightening rod or worse a blow torch. I thank you for your insight. I read another comment earlier on this blog. the individual said that he gets relief from going to a swimming pool. I could see how this could be helpful. I will try this method, because the moment I read it I immediately was drawn to the idea. Thanks for your input, medicine has yet to work completely for me, but I do feel exercise and relaxation techniques are helpful in the short term. I just wonder if I will have to be this way until I die. I had no issues at all until I was around 35 or so, then my whole world came apart. I liken it to my personality fracturing. To say the least, nothing I have ever experienced has scared me more than living like this. Bless you all, and I hope you all find peace. Thank you.
An article from your personal blog "Calming The Cycle Of Anxiety"
has come in quite handy lately. My what if-Ing GAD symptoms tend
to take on a life of their own and have been known to lead to mania
If they are not reined in early...
Changes at work have recently increased my anxiety to
almost unbearable levels then when I came home from a
yoga class today I find a letter slipped under my door from
Corrections Canada warning me of a pedophile that has
recently moved into my building. It's brought up some
old childhood issues for me. I was on the downturn of
a recent manic episode where I was going days on only
3 hours of sleep. Trying to remain stable has been a real
i'm diagnosed with ptsd, anxiety, depression and DID. i have symptoms similar to what you describe. should i talk to my psychiatrist? i wear shoes all the time because i rub my feet together and it keeps me awake and drives my sister crazy. also at night i sometimes get so anxious i can't stop moving and inside i feel terrible, like i'm being tortured. and i get pain in my legs. but i don't think i have bi-polar. what do you think?
thank you, jen
This is how psycho motor agitation manifested itself in me
Before I was diagnosed with bipolar disorder I was prescribed antidepressants that sent me into a mixed state, highly manic one moment then deeply depressed the next. I felt incredibly anxious, restless, paced alot, couldn't sleep. Burned out relationships with constant need to talk. Felt like a needle struck on a record player, did alot of repetative things like playing with tarot cards non stop 24/7. (I was extremely concerned about my future and looking for answers). Tried all the normal things to calm down meditation tapes, warm bubble baths, avoiding coffee, etc. Nothing worked not even Ativan. The stress on my mind and body was too much and preceed a brief psychotic episode. For me psychomotor agitation is a prodromal warning that something is wrong and I need to get help.