Treatment of Psychomotor Agitation in Bipolar Disorder

Mental Agitation That Manifests With Frenetic Activity

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Psychomotor agitation is an increase in purposeless physical activity often associated with depressive and manic episodes of bipolar disorder. Psychomotor agitation is a classic symptom that most people readily associate with mania: restlessness, pacing, tapping fingers, dashing about meaninglessly, or abruptly starting and stopping tasks.

While it can take many forms and vary in severity, it is an indication of a mental tension that cannot be managed and one that manifests physically with frenetic activity.

Causes of Psychomotor Agitation

While the condition is not well understood, we do recognize that psychomotor agitation is an integral feature of not only bipolar disorder but other mental and physiological conditions, as well, including:

  • Alcohol withdrawal
  • Anxiety disorder
  • Claustrophobia
  • Dementia
  • Panic attacks
  • Parkinson's disease 
  • Post-traumatic stress disorder (PTSD)
  • Psychoactive drug use
  • Traumatic brain injury 

Psychomotor Agitation in Bipolar Disorder

The features of psychomotor agitation can change, sometimes subtly, based on the type of episode a bipolar individual is experiencing:

Manic Episode

During a manic episode, psychomotor agitation will usually be accompanied by racing thoughts or "flight of ideas." When this happens, thoughts and emotions often become so overwhelming that they are literally channeled into physical motion. This agitation is commonly accompanied by something known as pressured speech, a type of frenzied, rapid-fire talking that can border on babbling.

Manic or Hypomanic Episode with Mixed Features

During a manic or hypomanic episode with mixed features, people with bipolar disorder will experience depression alongside the agitation and anxiety that come with mania. It's a period of increased vulnerability where a person may seem more irritable and emotionally fragile than during a manic phase. 

Depressive Episode

During a depressive episode, agitation may seem contradictory to the emotional state but is actually a common feature of this phase. Rather than it being an expression of manic behavior, psychomotor agitation is fueled by the anxiety and helplessness one inherently feels during a severe depression. 


When faced with psychomotor agitation, it is important to explore all possible causes before prescribing medication to treat it. In some cases, the drugs used to stabilize moods during depression can cause extreme anxiety and, in some cases, even suicidal thoughts.

At other times, an event, co-existing condition, or illness unrelated to bipolar disorder may have triggered the response. In the end, it's important to never make assumptions, whether you are the person living with bipolar disorder or a loved one coping with the sometimes extreme emotional changes.

Once all other issues are ruled out, treatment will focus on the gradual reduction of anxiety using medication, counseling, self-help techniques, or a combination of the above.

Anticonvulsants or mood-stabilizing drugs may be especially helpful during a manic phase. By contrast, atypical antipsychotics can often help when agitation occurs during a depressive episode. Anti-anxiety medications such as benzodiazepines may be prescribed to help manage generalized anxiety. 

In addition to drug treatment, cognitive (talk) therapy is considered important in the management of anxiety disorders. Self-help techniques can include meditation, exercise, yoga, breathing exercises, music therapy, and the avoidance of any emotional trigger known to cause anxiety.

If you or a loved one are struggling with a mental health condition, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

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2 Sources
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  1. Judd LL, Schettler PJ, Akiskal H, et al. Prevalence and clinical significance of subsyndromal manic symptoms, including irritability and psychomotor agitation, during bipolar major depressive episodes. J Affect Disord. 2012;138(3):440-448. doi:10.1016/j.jad.2011.12.046

  2. Hu J, Mansur R, Mcintyre RS. Mixed Specifier for Bipolar Mania and Depression: Highlights of DSM-5 Changes and Implications for Diagnosis and Treatment in Primary Care. Prim Care Companion CNS Disord. 2014;16(2). doi:10.4088/PCC.13r01599

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