Psychomotor Agitation and Hypomania in Bipolar Disorder

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, 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:

• Anxiety disorders
• Dementia
• Major depressive disorder
• Parkinson's disease 
• Post-traumatic stress disorder (PTSD)
• Schizophrenia
• Substance use (i.e., alcohol, opioids, marijuana, or psychoactive drugs)
• Traumatic brain injury (TBI) 

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. 

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.

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.

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.