Agitation

What is agitation?

Agitation is a feeling of irritability, mental distress or severe restlessness. It may feel like inner tension. And it often involves involuntary (out of your control) behaviors that serve no clear purpose, like fidgeting. Agitation can range from mild to severe and can develop rapidly or slowly. It can be brief or long-lasting.

Agitation can develop from a wide range of medical conditions. But brief, mild episodes of agitation are also a normal part of being human. Stressful or frustrating situations can make you feel agitated.

You may be wondering: How do I know if agitation is a medical problem? There’s not a clear answer. But if agitation is interfering with your day-to-day life, relationships or work, you should see a healthcare provider for help. If agitation escalates to aggression, suicidal behaviors or violence, you should seek immediate medical help.

Researchers don’t know the exact cause of agitation. But they think it involves an imbalance of certain neurotransmitters (chemical messengers), like dopamine, serotonin and others.

Signs of agitation

Examples of behaviors and characteristics of agitation include:

• Being uncooperative.
• Clenching your fists or wringing your hands.
• Difficulty focusing.
• Excessive talking.
• Fidgeting (purposeless movements).
• Hostility.
• Inner restlessness.
• Lack of impulse control.
• Pacing.
• Violent or disruptive behavior.

Sometimes, people express agitation as aggression. This can be verbal or physical and be directed at objects or other people. In some cases, agitation may lead to self-harm. An agitation crisis happens when a person is so agitated that they could be dangerous to themselves or others.

Not everyone experiencing agitation will have all these behaviors or characteristics. You may be able to recognize that you’re agitated, or you may not be aware of it.

It’s very important to seek medical help if you or a loved one are experiencing frequent or worsening agitation. Agitation may lead to an increased risk of suicide and violence.

What are the most common causes of agitation?

Agitation can develop due to many issues and situations, like:

• Chronic (long-term) conditions.
• Complications of a sudden (acute) illness.
• Side effects of medications.

It’s also common to experience mild, brief agitation without having an underlying condition.

Some of the most common medical causes include:

• Delirium.
• Dementia (like Alzheimer’s disease).
• Infections (like UTIs), especially in people over 65.
• Electrolyte imbalances.
• Hyperthyroidism.
• Physical trauma, especially head trauma.
• Postictal seizure state (the period that begins when a seizure ends).
• Sepsis.
• Substance intoxication or withdrawal (like alcohol, nicotine, marijuana, hallucinogens, opioids and others).
• Toxin exposure (poisoning).

Agitation can be a part of certain mental health and neurodevelopmental conditions, like:

• Autism spectrum disorder.
• Anxiety disorders.
• Bipolar disorder.
• Depression.
• Schizophrenia.

Experiencing intense stress or trauma can trigger or escalate agitation. New environments — like being in a hospital — can also trigger agitation or make it worse.

Agitation in dementia and Alzheimer’s disease

Agitation is a common part of dementia and Alzheimer’s disease. Changes to your brain make it difficult to process new information. And dementia causes an imbalance of neurotransmitters, too. These can both trigger agitation.

Your healthcare team can work with you and your loved ones to address agitation in dementia and reduce triggers of it. This may include strategies like simplifying your routine and environment. Medication may also help.

What is the treatment for agitation?

Treatment for agitation depends on several factors, like:

• The context (if you’re at home or in a hospital, for example).
• The cause.
• The severity of the agitation.

If a physical or mental health condition is causing agitation, treating the underlying cause is the main goal. But the behaviors of agitation — like combativeness — can make it difficult to receive treatment. Because of this, healthcare providers have several strategies for initially managing agitation. In general, they include:

1. De-escalation: A healthcare provider will speak calmly with the agitated person. They’ll make sure the agitated person’s concerns are being heard and appropriately addressed. Sometimes, de-escalation is all that’s necessary to manage agitation.
2. Seclusion: If de-escalation isn’t working — or as a part of de-escalation — a provider will ask the agitated person if they’d like to go into a quiet room (not force them to). This calming environment can help resolve agitation.
3. Medication: If de-escalation and seclusion haven’t helped manage agitation, medication is the next step. Providers typically use medications that cause sedation (relaxation), like second-generation antipsychotic medications or benzodiazepines. The type of medication they use varies depending on the underlying cause of the agitation.
4. Restraints: Physical restraints are an absolute last resort for managing agitation. Healthcare providers only use this method if the other methods haven’t worked, and the agitated person is at risk of self-harm or harming others.

If agitation is a symptom of a chronic (long-term) condition you have, your provider will work with you to figure out a treatment plan. Medication and psychotherapy (talk therapy) are usually key parts of the plan.

Don’t hesitate to reach out to your provider if you’re concerned about agitation episodes — the sooner you get help, the better.

How can I make agitation go away?

You may need medical treatment for moderate to severe episodes of agitation. But for mild episodes, the following strategies may help you relieve agitation:

• Minimize conflict and remove yourself from situations that are causing you distress.
• Relax in a dark, quiet room free of stimulation.
• Take a walk or do another type of physical activity you enjoy.
• Practice meditation or deep breathing.
• Listen to music that helps keep you calm.
• Write in a journal.

If agitation is a part of a chronic condition you have, it may take some time to figure out which strategies work best for you. Try to make a plan so you know what to do when agitation begins.

How do I deal with an agitated person?

If you or a loved one have experienced significant agitation before, take steps to develop an action plan in case the agitation gets worse. Start by talking with your healthcare team. They can offer guidance on de-escalation strategies and the best places to seek medical treatment quickly.

Agitation often comes from a feeling of loss of control. So, techniques that center on the person and don’t force them into situations or treatment offer the best chance for a fast recovery.

General techniques for de-escalating an agitated person include:

• Remaining calm: A purposeful demonstration of calmness and composure can make de-escalation more likely to happen. Use a calm, slow tone and a relaxed but attentive body language.
• Changing the setting: If possible, remove people and distractions from the area or ask the person if they’d like to go to a quiet room.
• Respecting personal space: Maintain a safe distance and avoid touching the agitated person. Use restraints only if the person is at risk of harming themselves or others, and there’s no other way to control their behavior.
• Listening: Give your full attention to the agitated person. Ask simple questions and avoid changing the subject or interrupting them.
• Empathizing: Show genuine concern and a willingness to understand without judging. Your tone and body language play an important role in this, not just your words.

Remember that your safety and the safety of others is the highest priority. Maintain a safe distance and avoid being alone with someone who’s potentially violent. If there’s a risk of imminent violence, remove yourself from the situation and seek safety. Call 911 or your local emergency services for help.

What are the possible complications of agitation?

If agitation is a frequent issue — or it becomes severe — it can lead to certain complications, like:

• Safety concerns: Agitation that leads to aggression or violence can create safety concerns for yourself and/or others.
• Health concerns: Agitation can be a barrier to receiving the treatment you need. You may have difficulty explaining your symptoms to a healthcare provider during an episode of agitation. Or you may refuse medical treatment. Frequent agitation can also make it difficult to sleep. A lack of sleep can have countless negative effects on your overall health.
• Relationship issues: Frequent agitation episodes — and the behaviors that accompany them — can strain your relationships with others.
• Issues with school or work: Being in an agitated state makes it difficult to focus or concentrate. This can make completing work or school tasks almost impossible. Frequent agitation can also create tension with your coworkers and peers.
• Legal issues: Agitation can make you act impulsively or violently. This could lead to legal action or arrest.

For all these reasons, it’s important to see your healthcare provider if you or a loved one are experiencing frequent or severe episodes of agitation.

When should I see my healthcare provider about agitation?

See your healthcare provider for agitation that:

• Lasts a long time, like several hours or days.
• Is very severe.
• Is interfering with your day-to-day functioning.
• Occurs with thoughts or actions of hurting yourself or others.
• Occurs with other unexplained symptoms.

If you have suicidal thoughts or behavior, dial 988 on your phone to reach the Suicide and Crisis Lifeline. You can also dial 911 or the local emergency number or go to the hospital emergency room.