Psychomotor Agitation and Hypomania 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.

What Is Psychomotor Agitation?

Psychomotor agitation is a classic symptom that most people readily associate with mania: restlessness, pacing, tapping fingers, fidgeting hands, dashing about meaninglessly, or abruptly starting and stopping tasks.

Psychomotor agitation is also a potential hypomanic symptom that people with bipolar II disorder or cyclothymic disorder may experience. You can define hypomania by its shared features with mania—irritable or elevated mood—but hypomania is less intense than mania.

While it can take many forms and vary in severity, psychomotor agitation is an indication of a mental tension that a person cannot control and that manifests physically with frenetic activity.

Symptoms of Psychomotor Agitation

Psychomotor agitation may affect behavior, cognition, and physical movement. Symptoms include:

  • Complaining
  • Delusions or hallucinations (in people with schizophrenia)
  • Difficulty breathing
  • Disorientation
  • Headache
  • Impaired self-control
  • Inability to focus or pay attention
  • Inappropriate motor activity (i.e., tapping fingers or fidgeting hands)
  • Irritability
  • Muscle tension
  • Physical weakness
  • Refusal to communicate
  • Sweating
  • Tachycardia (rapid heart rate)
  • Tremors
  • Uncooperative behavior
  • Wandering aimlessly

Causes of Psychomotor Agitation

Experts recognize that psychomotor agitation is an integral feature of not only bipolar disorder but other mental and physiological conditions as well, including:

Psychomotor Agitation and Hypomania in Bipolar Disorder

The features of psychomotor agitation can change, sometimes subtly, based on the type of episode that a person with bipolar is experiencing.

Manic Episode

During a manic episode, psychomotor agitation will usually be accompanied by racing thoughts. 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. 

What Is a Hypomanic Episode?

A hypomanic episode is a period in which someone experiences an "elevated, expansive, or irritable mood." Additional symptoms like inflated self-esteem, feeling less need to sleep, speaking quickly and more frequently, racing thoughts, and psychomotor agitation may also occur.

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. 

Diagnosing Psychomotor Agitation

It's important to see a doctor or mental health professional right away if you have signs of psychomotor agitation. There are measurement scales that doctors or psychiatrists use, for instance, to measure whether your symptoms are mild, moderate, or severe.

But a doctor will also assess your symptoms in the context of your overall health, likely performing a physical exam and examining your medical history.

If a person's symptoms are severe and may cause harm either to themselves or others, they may be admitted for emergency care at a hospital or mental health facility.

Treatment for Psychomotor Agitation

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, such as Tegretol (carbamazepine) or Depakote (sodium valproate) may be especially helpful during a manic or hypomanic phase. By contrast, atypical antipsychotics, such as Seroquel (quetiapine) or Prozac (fluoxetine), 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 behavioral therapy (CBT) is considered important in the management of mental health disorders. Self-help techniques can include meditation, exercise, yoga, breathing exercises, music therapy, and coping with emotional triggers 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.

A Word From Verywell

Experiencing the signs of psychomotor agitation can feel frustrating, worrisome, and stressful. But remember, you aren't alone. Talk to a doctor right away if you experience psychomotor agitation; they can help you manage your symptoms and address any underlying mental or physical health issues. There are medications and coping skills that can help you address the impact psychomotor agitation has on your life.

Frequently Asked Questions

  • What causes someone to have psychomotor agitation?

    Psychomotor agitation may be caused by depressive, manic, or hypomanic episodes in bipolar disorder, or another mental health condition such as anxiety, depression, or schizophrenia. It may also be caused by a physical health issue such as a brain injury.

  • What is hypomania and can it be treated?

    Hypomania is a period of elevated mood experienced by people with bipolar II disorder or cyclothymic disorder. It causes restlessness and in some cases, psychomotor agitation. Hypomania can be treated; some doctors prescribe a medication such as an anticonvulsant or antipsychotic.

  • Does having psychomotor agitation mean that you also have bipolar disorder?

    Not necessarily. While psychomotor agitation does occur in some people with bipolar disorder, it can be caused by a number of other mental or physical conditions.

10 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading

By Marcia Purse
Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing.