I am suffering from severe bipolar-related agitation. Or is it severe medication-related agitation? This is the question. Technically, it’s mostly a question for your doctor, but it’s one I struggle with, too. On one level, it doesn’t much matter what’s causing the agitation as it’s happening and that’s that; and on the other hand, I think it’s important to know what’s driving the agitation – a bipolar symptom or a medication side effect?

‘Psychomotor Agitation’ and Bipolar Disorder Mixed Moods

Technically the term for this is “psychomotor agitation” and I’ve written about it before. It’s this sucky mental and physical agitation (and in my case, it feels like psycho-agitation [ha] more than motor-agitation but the motor is there as well). It’s a symptom of depression and I find it to be prevalent in mixed moods, but that’s me.

And while I identify as a bipolar that struggles with depression the most, if you really look at my symptoms you’ll see that it’s often really a mixed mood and not straight depression from which I am suffering. For example, while I suffer from anhedonia (an inability to experience pleasure) – a depression symptom, I also tend to experience excessive talking/pressured speech – a hypomania symptom. (Other symptoms occur as well.)

To me, massive agitation (technically a depression symptom) also aligns itself with irritability, a hypomania symptom.

What Does Severe Agitation in Bipolar Disorder Feel Like?

It’s hard to describe severe agitation but let me try:

  • The last time I tried to explain it to my doctor, I said it was like sandpaper was grating against my cells, or maybe veins. He said, “How does that work?” Arg.
  • I think I have a better explanation now. Severe agitation feels like anxiety, stress, irritability and anger all in one. The state of agitation is one where I can’t separate those feelings. They are just happening all at once, making me miserable. There also seems to be a useless, frantic energy involved.

I keep saying to myself, “I’m so stressed out.” But this isn’t what’s happening. What’s happening is that I’m so agitated. Saying “I’m so stressed out” seems to make more sense to some superficial part of my brain.

I think this is because when you have a lot of work to do and it seems reasonable to be stressed out that’s what you think you are. But I’m not. I’m bipolar and I’m agitated.

Agitation as a Bipolar Medication Side Effect

Of course, agitation or anxiety or irritability for that matter can be a bipolar medication side effect. I’ve experienced this, too. I’m aware one of my bipolar medications worsens this feeling and I suspect a medication new to the cocktail is amplifying it further.

But you never really know. Bipolar is sneaky that way.

Agitation – Bipolar Symptom or Med Side Effect? How Do You Know?

Severe agitation in bipolar disorder can be a symptom or a meds side effect but how do you know whether agitation is a side effect or a symptom?For medication side effects there’s always one telltale sign: if it started right after starting a new medication (or changing a dose) then it’s a medication side effect. That’s the easy part.

The hard part is knowing whether agitation is related to your bipolar directly. Bipolar symptoms do come and go for many people so severe agitation could be a bipolar symptom for you.

And, of course, it could be a combination of the two. Severe agitation could have been mild and waiting in the wings for just the right medication to bring it out on stage.

Dealing with Severe Agitation in Bipolar Disorder

This is the tricky part.

If your severe agitation is symptom-related, then medication may help you. If your agitation is medication-related then only a medication change can help you. That’s why it would be nice to know the cause of the severe agitation in the first place.

On a daily level, I’m not sure I am of any help.

What I have to do is take a PRN (taken as needed) benzodiazepine medication. I hate doing it but it’s literally the only thing that works. All of my other calming-down tricks don’t work anymore since the agitation became so severe. Yoga (never a big one for me) – no. Relaxation exercises – no. Meditation – no. Self-talk (I have to use it just to function but other than that) – no. Literally, nothing touches agitation this severe for me except medication. That’s the truth.

All that said, I am still looking for a better solution. I’m sure it will involve a medication change. Using a PRN benzodiazepine medication is not a great long-term solution and I’d really like to curtail its use.

I guess, in short, severe agitation needs to be treated as a bipolar problem, whether it turns out to be a side effect or a bipolar symptom. And remember, something with the word “severe” in front of it should never be ignored – not by you and not by your doctor. Because one other thing I will say is that while none of the above positive coping skills are useful, my body does try to find negative coping skills to use too, and that never ends well.

So take severe (or even not-severe if it’s causing you distress) agitation seriously. Your peace is worth it.