What Causes Agitation?

Medically Reviewed by Poonam Sachdev on April 15, 2024
Written by Keri Wiginton, Kristin Mitchell, Allison Torres Burtka
8 min read

Agitation is a feeling of severe restlessness, crankiness, or uneasiness. When it happens, you may feel mentally distressed. Physically, you may feel like you can’t sit still, so you may pace or wring your hands. 

Agitation is a normal emotion. But it’s more likely to show up when you’re under a lot of stress. 

It can also happen if you use drugs, withdraw from alcohol, or if you have certain medical conditions. It’s pretty common to feel unsettled if you have hormone problems or a psychological condition like schizophrenia, bipolar disorder, or dementia. Rarely, agitation may be caused by a brain tumor. That’s why it’s important to talk to your doctor if you get agitated, especially if you feel like it’s for no reason.

 

 

 

Early signs of agitation include:

  • Clenching your fists
  • Outbursts
  • Picking or pulling at your hair, skin, or clothes
  • Shuffling your feet
  • An urge to move, maybe with no purpose
  • Uneasiness
  • Crankiness
  • Impatience
  • Stubborn behavior (often toward caregivers)

Signs that agitation is getting worse include:

  • Disruptive or violent behavior
  • Excitement
  • Hostility
  • Poor impulse control
  • Tension
  • Unhelpfulness

Sometimes, agitation involves aggressive behavior, but agitation isn’t the same as aggression. Unlike aggression, agitation typically involves unintentional behaviors that come from a feeling of inner restlessness. It’s also different from akathisia, a movement disorder that’s often caused by antipsychotic medication.

It’s normal to get worried if you or a loved one is agitated a lot. If you feel agitated a lot and you don’t know why, talk to your doctor. They can give you tests to find out what’s causing the condition. 

And if you or a loved one is thinking about suicide or hurting yourself, tell someone right away. You can reach out to a friend, family member, or a health care professional. You can also go to the emergency room, or call or text the 988 Suicide & Crisis Lifeline any time, day or night.

Agitation can have many causes, from a situation that stresses you out to a serious medical condition. And because the causes can vary, there are a variety of proper treatments, too. 

Here are some potential causes of agitation.

Schizophrenia

You may not be able to control your emotions or actions. Schizophrenia can also make it hard to tell what’s real. That can make you feel troubled. You may or may not be able to manage your agitation. That’s why it’s important to talk to your doctor when you feel uneasy.

To treat your agitation, your doctor may prescribe:

  •  Antipsychotics
  •  Benzodiazepines (also called “benzos”)
  • Talk therapy
  •  If nothing else works, physical restraint may be needed

Bipolar disorder

Bipolar disorder is a mood disorder that can cause strong swings in your emotions and energy levels. Your mood can cycle between good and bad feelings, or you can have both at the same time. If bipolar disorder causes your agitation, you might also have manic episodes, or “up” periods of high energy and fast thoughts, as well as depressive episodes, or “down” periods of low energy and sometimes suicidal thoughts. Agitation is common in people with bipolar disorder. 

Treatment may include:

  • Medication, such as diazepam 
  • Mood stabilizers
  • Psychotherapy, like cognitive behavioral therapy

Alzheimer’s disease and dementia

Alzheimer’s disease is the most common type of dementia, which causes symptoms including memory loss, confusion, and trouble solving problems. You may get frustrated and not be able to control your feelings. Sometimes, this sort of frustration and changes in your brain can lead to agitation.

If you or a loved one has Alzheimer’s or dementia, treatment for agitation may include:

Autism

Autism spectrum disorder (ASD) is a sensory and behavior disorder that can make social situations hard. You may get upset if you have trouble communicating, and you may feel like you need to repeat certain behaviors to calm down. 

Sometimes, certain situations can trigger agitation in people with autism. To address your symptoms, you may need a personal approach. Your doctor may give you:

Stress

Stressful situations can lead to agitation. Stress can come from many sources, such as problems at home, work, or school. And if you’re already agitated, stress can worsen the condition. 

To manage stress, you may want to:

It may be hard to control your stress on your own. That’s when you should talk to your doctor. They may want you to try medication or therapy. And go to the hospital if you have chest pains or a hard time breathing, because that may be a sign of something serious, like a heart attack.

Hypothyroidism

Agitation may be a sign of hypothyroidism. That’s when you don’t make enough thyroid hormone. Without this chemical, your brain and body don’t work very fast. It can happen if you get radiation treatment, have surgery on your thyroid, or you have an autoimmune condition, like Hashimoto’s thyroiditis.

Treatment for your hypothyroidism should ease your agitation. Your doctor will give you medicine to bring your hormone levels back to normal.

Hyperthyroidism

If you have hyperthyroidism, your thyroid is overactive – it produces too much thyroid hormone. Hyperthyroidism can cause agitation, especially if you having an emergency called thyroid storm, when your thyroid releases a large amount of hormone in a short amount of time. 

Treatment for hyperthyroidism may include medication or thyroid removal surgery. But if you think you have thyroid storm, you should get emergency medical attention right away.

Menstrual cycle

Hormone changes before your period can make you feel tense. But you may get really overwhelmed and agitated if you have premenstrual dysphoric disorder (PMDD). It’s a more serious form of premenstrual syndrome (PMS).

Treatment for symptoms of PMDD may include:

It’s important to talk to your doctor if you have these symptoms every month. It may be a sign that your menstrual cycle is actually making a mood disorder worse.

Agitation can be a symptom of depression, a mood disorder that causes a persistent feeling of sadness. Sometimes the term “agitated depression” or “mixed depression” is used to describe a type of depression that involves agitation. For example, you may feel depressed or anxious, along with being restless and having racing thoughts.

Experts are still learning how agitated depression is different from depression.

In a recent study, one-quarter of people with agitated depression had racing thoughts, pressured speech, and increased motor activity. One-quarter had paranoia, aggression, and crankiness. While symptoms like changes in movement and crankiness may be linked to depression, symptoms like pressured speech and paranoia aren’t typical symptoms of depression.

People with agitated depression had longer recovery times than people with non-agitated depression. Their episodes also lasted longer.

It’s not clear why, but people with agitated depression tend to be hospitalized in a psychiatric department more than people with non-agitated depression. They’re also more likely to get their first psychiatric care treatment at a later age.

Who's at risk of agitated depression?

Agitated depression may be linked to:

Bipolar disorder. Recent studies suggest agitated depression is common in people who have bipolar disorder. In one study, one-fifth of people with bipolar disorder also had agitation. In another study, it was closer to 25%. In a third study, one-third of people with bipolar depression had agitation.

With bipolar disorder, you have mood swings that cycle between depressive episodes and manic episodes. Agitation may happen during manic periods.

Clinical depression. You may also have agitated depression if you have clinical depression or panic disorder. Agitated depression has been linked with depressive symptoms, panic disorder, and suicidal behavior.

One study found that agitated depression was more common in women, started at an earlier age, had more recurrent episodes of depression, and came with more atypical features, depression symptoms, and family history of bipolar disorder.

If you have agitated depression, your doctor may treat you for depression, bipolar disorder, or a condition that may be causing agitation.

Your doctor will create a personalized treatment plan for you.

Your treatment plan may include:

  • Medication
  • Counseling or talk therapy
  • Peer support
  • Wellness strategies

Doctors are trying to understand which treatments are best for agitated depression. Antidepressants, which doctors often prescribe for depression, may make you more agitated. 

It’s possible that antipsychotics, anti-epileptics, lithium, and benzodiazepines may help. Your doctor may give you a fast-acting medication to use temporarily if you’re severely agitated. After agitation decreases, your doctor may recommend antidepressants with close monitoring of your symptoms.

Electroconvulsive therapy may also be an effective treatment for agitated depression.

Agitation is a common feeling, and it might happen because something has stressed you out, but it also might happen because of a medical condition. You may need help managing it if you feel agitated often or you feel severely agitated. It’s important to talk to your doctor about your symptoms, to address any related medical issues, and to get treatment that will help you feel better.

  • What is the difference between agitation and anxiety? Like agitation, anxiety can make you feel uneasy. But anxiety may also feel like fear or dread, and if you have an anxiety disorder, your anxiety may worsen or not go away. Sometimes you may get agitated during severe anxiety.
  • What is the first-line treatment for agitation? The first option to respond to agitation is to create a calming environment. But it’s also important to address the cause of your agitation, which can vary from stress to a medical condition. 
  • What are the levels of agitation? Feelings of agitation can range from mild to severe. Physical behavior can also vary, from pacing back and forth to strong outbursts.

If you feel agitated a lot and you don’t know why, talk to your doctor. They can give you tests to find out what’s going on.

And if you or a loved one is thinking about suicide or hurting yourself, tell someone right away. You can reach out to a friend, family member, or a health care professional. You can also go to the emergency room or call the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255) any time, day or night.