Psychomotor Agitation: Symptoms, Treatment, & How to Cope

What Is Psychomotor Agitation?

Psychomotor agitation refers to unintentional and purposeless motions that occur due to mental tension. Common motions include pacing, foot tapping, hand-wringing, and fidgeting when seated. It is often seen in major depressive disorder, bipolar disorder, anxiety, and attention-deficit/hyperactivity disorder (ADHD). Psychomotor agitation can be a sign of an underlying condition, and consideration of this symptom and other signs and symptoms can help guide diagnosis and treatment.

Signs & Symptoms of Psychomotor Agitation

Signs and symptoms of psychomotor agitation include physical movements like pacing around, behavioral signs like getting out of one’s seat during class or behaving aggressively toward others, and cognitive signs like talking in a very rapid or pressured way.²

Behavioral signs and symptoms of psychomotor agitation include:

• Dashing or running around
• Aggressive behavior toward others
• Agitation and irritability
• Inability to sit still
• Disrupting others

Cognitive signs and symptoms of psychomotor agitation include:

• Rapid speech
• Jumping quickly from one thought to another
• Repeating words or phrases

Physical signs and symptoms of psychomotor agitation include:

• Restlessness
• Tapping your drumming fingers
• Pacing back-and-forth
• Shaking legs
• Fidgeting with objects
• Picking at skin

Causes of Psychomotor Agitation

Psychomotor agitation is often caused by mental illnesses like bipolar disorder, anxiety, or ADHD. It can also be caused by substance abuse or withdrawal or be a side effect of certain medications. Neurological conditions like Huntington’s and Parkinson’s disease can cause psychomotor agitation as well.

Potential causes for psychomotor agitation include:

Depression

Most often, depression causes a loss of energy and motivation; however, it can also have the opposite effect and cause psychomotor agitation. Some people with depression feel more agitated and restless during depressed episodes. This can be a different presentation of depression than people are used to seeing, which can cause it to be overlooked.⁴

Anxiety

Anxiety causes a heightened state of arousal and nervous energy. This often causes people with anxiety to feel like they need to move or fidget to release this energy, leading to pacing, fidgeting, tapping, or other movements. Anxiety causes the body’s fight or flight response to kick in, which creates nervous and restless feelings.

One of the primary symptoms of anxiety is being worried about a number of different things, and these racing thoughts and ruminations can result in an increase in nervous energy. Psychomotor agitation may be the result of needing somewhere for this internal restlessness and anxiety to go.

Bipolar Disorder

In bipolar disorder, psychomotor agitation is most often associated with the manic phase. People who are experiencing a manic or hypomanic episode often have excessive amounts of energy or agitation, which can cause them to feel restless or unsettled in their bodies. This can lead to pacing, picking, fidgeting, or other behaviors.

A person in a manic phase will often find it difficult to channel their excessive energy, and this may come out as movement, behaviors, or pressured speech. The decreased need for sleep that comes with mania can lead to even more restlessness. It is important to remember that not everyone with bipolar disorder will experience psychomotor agitation, but it is a common symptom.³

Attention-Deficit/Hyperactivity Disorder

One of the classic hyperactive-impulsive type ADHD symptoms is psychomotor agitation. People with this type of ADHD may feel full of nervous energy that they need to do something with. This can result in ADHD-induced fidgeting pacing, jumping around, climbing, fidgeting, or getting out of their chair. This is one of the primary ways that ADHD can cause a lot of problems in school.

Substance Use

Many substances, such as stimulants, can cause hyperactivity, restlessness, and psychomotor agitation. This is due to the stimulant’s effects on the nervous system, causing an increase in restless energy. This often affects judgment and impulse control, which can lead to impulsive behaviors. This psychomotor agitation can cause additional struggles for a person using substances.⁵

On the other hand, withdrawal from substances can also contribute to psychomotor agitation. As people withdraw from a substance, they may find that their body feels as if they are jumping out of their skin. This results in an increased instinct to move and get rid of the nervous energy. Substance abuse prevention efforts aim to reduce this and other symptoms caused by addiction.

Medications & Withdrawal

Prescriptions, including antipsychotic medications, can cause psychomotor agitation. Stimulant medications such as medications prescribed for ADHD and steroids are also known to cause agitation, restlessness, and increased movement. Psychomotor agitation is a symptom of withdrawal from certain medications like benzodiazepines, which can result in the same symptoms of restlessness, irritability, and excessive movement.

Medical Conditions

Certain medical conditions, such as hyperthyroidism or neurologic disorders, can contribute to psychomotor agitation. An overactive thyroid can lead to an increase in nervous energy, and neurological disorders like Parkinson’s or Huntington’s disease can result in involuntary movements or restlessness. Traumatic brain injuries can also result in psychomotor agitation when they impact parts of the brain that control movement. Additionally, certain infections that affect the nervous system, neurotransmitter imbalances like dopamine and serotonin, and certain metabolic disorders can all cause psychomotor agitation.²

Trauma

After a traumatic event, it is common to experience a fight or flight response when a present-day trigger sets off the amygdala in the brain. This causes a person to feel as though the trauma is happening again, which results in nervous energy in the body and psychomotor agitation.

Impact of Psychomotor Agitation

Psychomotor agitation creates an ongoing feeling of nervous energy, restlessness, and an impulse to move, which can be extremely uncomfortable. It can result in problems at school or at work, making it difficult to stay in one place and complete the task at hand. It can also impact relationships when it results in distraction, irritability, or impulsive actions that may unintentionally harm others.

Treatment for Psychomotor Agitation

As difficult as it is to cope with psychomotor agitation, there are some treatments and medications available that can help reduce the impact of the symptoms and make it easier to cope.

Treatment options for psychomotor agitation include:

• Anxiolytics or sedatives: These medications are an effective short-term treatment option for psychomotor agitation. They are often used for relief and fast stabilization in a hospital or other acute setting.
• Cognitive-behavioral therapy (CBT): CBT helps by addressing underlying causes and symptoms that contribute to agitation. It also helps a person challenge negative thoughts that a person may have about themselves related to their symptoms.
• Dialectical-behavior therapy (DBT): DBT is a helpful treatment option for psychomotor agitation that helps a person learn to manage emotions and behaviors. DBT works by teaching skills for coping and tolerating distress to help a person regulate their emotions and have an improved quality of life.
• Mindfulness-based cognitive therapy: Mindfulness-based cognitive therapy can help a person enhance self-awareness and practice emotional regulation. It allows a person to experience the present moment without judgment and can reduce stress.
• Eye movement desnsitation and reprocessing (EMDR): EMDR can be a helpful modality when there is a history of trauma. Traumatic events can lead to nervous system dysregulation, which can worsen psychomotor agitation. EMDR works by desensitizing the nervous system and reprocessing past events so a person can experience calm in their body and remove triggers.

Hospitalization for Psychomotor Agitation

In cases of severe psychomotor agitation in which a person is at risk of harming themselves or someone else, or their symptoms are intolerable, hospitalization may be necessary. Hospitalization can provide a safe and supportive environment for crisis management and stabilization, and providers can prescribe medications and provide other services to help a person recover.⁶

How to Cope With Psychomotor Agitation

While psychomotor agitation is painful and uncomfortable to deal with, there are some practical tips and strategies that can help individuals cope and reduce the impact of the symptoms on their lives.

Here are some strategies that can help to cope with psychomotor agitation:

• Try deep breathing exercises. Slow, measured breaths, especially focusing on a longer exhale, can help cue the nervous system to relax.
• Practice mindfulness. Mindfulness can help by allowing you to notice your sensations and experiences without judgment. You may notice a restless need to get up and move around. With mindfulness, the key is not to judge yourself for that but to simply be curious about what that feels like and where you notice it in your body. This is not only a great exercise in self-compassion, but I can help you to focus on the present moment which reduces stress.
• Utilize progressive muscle relaxation: Progressive muscle relaxation involve tensing and releasing each muscle group in the body, one by one. This can alleviate some of the physical strain and restlessness that is associated with psychomotor agitation
• Incorporate movement and exercise: Regular physical activity can help you release excess energy and get that nervous, agitated feeling a place to go. This can help reduce the symptoms and help you feel better in your life in general.
• Limit caffeine and other stimulants. Reduce or avoid caffeine and other stimulant intake, and notice whether or not that makes a difference in your symptoms. It can help to keep a journal and track caffeine/ stimulant intake and symptoms each day.
• Use fidget toys and other sensory tools: Try playing with a fidget toy, fidget spinner, squishy toy, puzzle, putty, or other sensory item to release those restless feelings. You may find that this makes it easier to sit still and focus when needed.

When to Seek Professional Support

When psychomotor agitation has a negative impact on your work, school, sleep, or relationships, you may want to consider seeking professional help. While this may simply be a sign of increased stress and nothing to worry about, you also want to rule out any serious mental health or medical conditions. A therapist can help you cope with the difficult emotions related to psychomotor agitation.

An online therapist directory is helpful for finding a therapist who is skilled in working with psychomotor agitation. An online therapy platform is a good choice for people with limited transportation access or difficulty leaving their homes. A psychiatrist can help with medication management and help you find ways to manage symptoms. Online psychiatrist options are available for those who prefer to meet by telehealth.