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 2023, December 4 from https://www.healthyplace.com/blogs/breakingbipolar/2013/05/bipolar-symptoms-psychomotor-agitation
Author: Natasha Tracy
The movement and muscle clenching is uncomfortable but I can't take the feeling of my skull actually exploding as my brain swells and I'm unable to think. My insides want to get outside. I am inclined to hit stuff to feel a release. It's better if it hurts because then I feel something but only helps for a bit. It's hard to describe much of what I feel with BP but agitation is one the best words I found to describe my chaos without making people too uncomfortable.
Finally a name for it. But I only get it about 2 hours after I have taken my medication of 75mg seroquel XR. Its so bad I want to go off my meds! I stretch and stretch, throw my arms around but that only helps for a second if that. Odly enough I find that eating is the only thing to make it stop, but as soon as I stop eating it's back! I get it til I finally fall asleep then am fine during the day. I am going insane as I type this. I need to know how to stop it..... is there anyone, or yourself of course, who can help me!
I also wanted to add that my doctor prescribed me Limital and Celexa and says that because when I came to him since I was partaking in marijuana, I am an addict- so he won't prescribe anything stronger for fear of me becoming an addict.
I also take Vistril because I have horrible nightmares.
THANK you for this. Since childhood, I have had a thing with my toes moving them to the syllables that people use and to get to sleep.
When angry, frustrated, or excited, I shake. Sometimes violently. I have a
bad habit of shaking my legs.
my diagnosis are Bipolar 2 disorder, PTSD, and Depression.
I'm very smart, but sometimes the simplest conversations confuse me and
when I state my confusion, people get angry and frustrated causing
me to also get frustrated and cry. Sometimes resulting in Panic attacks.
In this moment, I am angry and shaking and I would love to damage something.
i been diagnosed with depression.flappy and lurchy arm moving at work,several attempts to grab things
i also developed a stutter and write down words or letters more than once....can't always read back and correct it.think work tolerates me
Psychiatry Physical and emotional overactivity in response to internal and/or external stimuli, as in hypomania.
I think this is a more inclusive, though brief, definiton. Note: Physical AND EMOTIONAL over activity...
Also left out, is the agitated feeling one has. Where the slightest thing gets on your last nerve. Someone eating, the buzzing of the light fixture outside, tying to screw on a cap that is cross threaded, someone sighing. These things make us feel agitated and we get impatient and angry. "Calm down" doesn't help. I did try DLPA-an amino acid. It helped tremendously. However, for me had two side effects I could not tolerate. The search continues. The best meds for me, I am allergic to. So I am having to try to find different approaches.
I came across your blog recently, and I am really enjoying your articles. Several times, I have caught myself nodding my head in agreement. Today was definitely one of those times. You described psychomotor agitation perfectly. I'm going to direct friends and family to this particular article to help explain it! The only way I've really been able to describe it to them so far is that when it's really bad, I feel like I'm going to crawl out of my skin. In the early stages, though, I pace (and change my clothes!) or play repetitively with a yo-yo. Now maybe my husband will be able to "notice" and help me monitor a turn toward hypomania.
It turned out when I had this problem for years, it was caused by the prescribed drugs. It was probably akathisia, or something like it, but I didn't pace around and when I described it, the docs just said it was "my illness," just like my cognitive problems, which have mostly gone away, but that took 3 years to happen (doc says brain damage from the drugs, he saw me recover over the years).
I still have bipolar, still get depressed as hell now that I'm off the drugs, but that horrid restlessness that made me 10X more suicidal is GONE and has been ever since about 6 months after I got off the drugs (which ONLY happened because I ran out of drugs to try, and ECT failed, too).
I'm not sure my message is too welcome here, but my point in posting on here is for those of you who go years and treatment never helps and you just get worse, consider if you are like me, and the drugs are causing more problems. In hindsight, docs all nod their heads and say "oh yes, akathisia is a very common side effect," and "It's well known that this drug causes aggression" and "a lot of people who think for a living won't take most of these drugs" and so on, but at the time, they said it was 100% "my illness" or later, as I got even worse, tacked on borderline to my diagnosis.
If this restlessness first showed up AFTER you got drug treatment, consider if it's your antipsychotic (maybe some other drugs do this too). The docs won't spot it unless it's blatantly obvious. And you know, I couldn't tell I was having cognitive problems until I recovered. I started science fiction writing again, and doing my other nerdy hobbies that I couldn't understand. Took 3 years off the drugs to be able to think well enough to pick that stuff up again. I seriously question if bipolar causes any sort of cognitive damage. Those docs were all so sure it was all my illness. Now without treatment, I'm back to the old roller coaster, but that's a lot better than I was doing with the akathisia and cognitive problems and NEVER cycling out of depression.
Thank you for posting this again. I had no idea that this had a name. I thought I was the only person doing repetitive movements in my little cubicle. I am busy at work all day. But I will lift up the very edge of the back of my shirt and scratch my back. Then I scratch the back of my hand before I continue with typing and working. I don't really have a ritual. I will do it random times during the day. But I never see others lifting up the very back of their shirt. I feel like I have to scratch my back. And sometimes my back is not really itching at all. It is something I have to do. It is almost as if I am cutting my stress and getting my head together for a few seconds so I can keep working. I don't do it at home watching TV very much. For me at least it goes with my work day. Thanks for letting me know about it.
Excellent information. I have this problem every single morning for about an hour or more. Legs wont stop moving, can't sit still, clenching eyes shut, trouble breathing because I hold my breath. I've had no idea what was causing this. I also do the ripping clothes on and off again thing on occasion and like another person responded the song thing going on in my head over and over and over again can't stop moving to this beat in my head. I will be talking to my doctor about this. Thank you so much. How do I get ongoing posts from your blog?
I think that I only experience this when I am feeliing very angry, afraid or upset (and have no outlet for that...). Most commonly it seems to be anger. I'm not totally sure what that says or means though...
My girlfriend had bipolar and she only started getting really bad agitation in the legs 24 months after starting seroquel 200 and avanza 30. She is trying magnesium but its not helping yet
From the moment I am conscious in the morning until I fall asleep I have a constant dialog or song running through my head, and I clench my muscles repeatedly to the beat until I am now extremely stiff. Like tapping my feet, but just clenching the muscles. Fingers, too. It stiffens all the way up my legs and arms. Dr. is trying me on 40mg Lexapro but I don't know if that's the right thing. I agree with jsoltys above. I am SO sick of it! and I can't stop it!!
This is horrible and I have this bigtime. I have to constantly shrug my shoulders up into my neck until it hurts. I have uncontrollable urges to tighten various muscles over and over. I also feel the need to squeeze my eyelids as tight as possible. It's such an out of control feeling and people look at my strangely sometimes. The only plus is that I burn a lot of calories throughout the day!
Describing that agitation is like nailing down a rain shower.
My best way to handle it is going to the pool. I can thrash all I want in the water and hurt nobody.
By the way Natasha, you are very pretty. Thank you for reaching out to us!
I just went to this blog as it was the first one that came up and found this information. I am not sure that I have this Psychomotor Agitation but the reason I was looking for a blog is more of a mental-emotional agitation. I am easily agitated at work when too many people are milling around my desk or the chatter makes me want to rip my ears off. I actually tell people to go away or get back to work, or I shut the door to block them out. I know the job I currently have is not a good fit for me, I am a receptionist and I am also box office sales and info booth for a concert venue. I need the job! So I am open to hearing how I might "unagitate" until the end of August when this job ends.
Hey I can relate to this topic for sure. Also to the others writing in. I have been experiencing this more lately since my cycles are woooow right now... Be Well all.
I think I just had an episode of that and the way I could describe it is I felt like I wanted to smash something or cry or just scream into a pillow. I had so much anger I didn't know what or how to do it. But finally I channeled it positively and constructively doing things that needed to be done and would help me.
I think my scratching is a form of this because I'm not really wanting to hurt myself as much as release tension and feel real again.
When I attempt to explain it to someone I generally tell them that everything inside of me, organs, muscles, everything, feel like a spring sprung way to tight and I have to move or figure out some way to release the pressure because if I don't I feel like I will explode.
great post. i related to it on a very personal level. i had to share it with my readers on my blog. thanks for bringing such important and upcoming information to the table for us all.
I never knew that their was a name for this but relate to it's symptoms... but I sometimes find with some of the repetitive actions I do a distraction from the maelstrom within. I also would like to note that I have had these behaviours since childhood and was forever getting into trouble over them for behaving (to quote my Mum ' like a caged tiger '
Also your page is great, useful, informative and well balanced. Thank you.
i have that symptom and i always thought it was from anxiety. my official diagnoses are DID, PTSD, anxiety and depression. should i be screened for bipolar? as far as i know i've never had mania or hypomania.
I think I can help you, but could you contact me privately please?
I've been following your blog for about a month now and I just wanted to say thank you for your honesty and for your advice. Your perception of this disorder is similar to mine and I love that you put in the time to do the research and find creditable sources. I wanted to ask if I could suggest a topic for you to discuss. I'm bipolar and I'm currently tapering off my meds to try to get pregnant. Do you have any advice on the best forms of natural treatment for bipolar during pregnancy. My doctor said I should try be med-free during conception and the first trimester if I can help it but recommended Zoloft and Letuda(I'm not sure on the spelling) if I get stuck in one of my moods and need help. What's your opinion on this topic?
Natasha, once again you shed light on something obscure about our condition. I appreciate all the research you do and your attempts to get to the bottom of things.
Hey Natasha, just discovered your blog. I think it's great. I just started a blog about my bipolar, I hope you'll visit! (So far, it's just an about me page and one post, but more to come!) Cheers.