Agitation: What to do if you are restless?

Agitation (also agitation) is an inner excitement manifesting in an insatiable urge to move. Agitation states can occur as a symptom of various diseases, such as depression or dementia, or as a side effect of taking certain medications. Drug use or drug withdrawal can also cause agitation. Here’s how to recognize agitation and what to do about it.

Agitation or nervousness?

It is essential to distinguish between agitation and simple restlessness or nervousness since agitation may require medical treatment.

The characteristic feature of agitation is the excessive need for movement. Agitated individuals tend to pace restlessly and are unable to sit still. In addition, they often show uncontrolled, aimless movements such as fidgeting, constantly tugging at their clothing or casually fiddling with objects. In psychology, these behaviours are summarized under the term “increased psychomotor skills”.

 

Unbridled urge to move as a sign

The patients usually feel a muscular inner tension and restlessness when agitated. In contrast to people generally nervous or tense in a stressful situation, agitated people cannot suppress the urge to move.

Increased irritability, even aggressive behaviour and uncontrolled outbursts of anger are often added. In rare cases, temporary placement in a psychiatric clinic may even be necessary to avoid endangering the person concerned or others.

causes and triggers

Several reasons can cause agitation:

• Agitation can occur as a symptom in the context of mental illnesses such as dementia, depression, schizophrenia, borderline personality disorder and anxiety disorder, as well as in the case of acute mental stress.
• Drug use,  alcohol abuse, and alcohol or drug withdrawal can all cause agitation, particularly if accompanied by impaired consciousness (delirium).
• Organic diseases such as severe hyperthyroidism, epilepsy, metabolic imbalances (e.g. in diabetes ) or electrolytes, as well as an asthma attack or lack of oxygen, can trigger a state of agitation.
• If signs of agitation occur in children, this can be an indication of Attention Deficit Hyperactivity Disorder ( ADHD ). In addition to an excessive urge to move, there are usually severe concentration disorders and a tendency to impulsive actions. If you notice these symptoms in your child in a highly pronounced form, you should seek the advice of a paediatrician or the help of a child psychologist.

 

Agitierte Depression

Agitated depression is a unique form of depressive disorder because the symptoms sometimes differ from the typical signs of depression. While those affected by classic depression usually complain about a lack of drive and show a slowing down of the movement sequences, agitated depression is characterized by restlessness and drive. In addition, there are usually tormenting states of anxiety and inner solid restlessness.

In some cases, this can lead to impulsive actions and, thus, to an increased risk of suicide. Therefore, it is essential to interpret the symptoms correctly and initiate psychotherapeutic treatment at an early stage.

Agitation as a side effect of medication

Agitation can be a side effect of certain medications. A so-called paradoxical reaction can occur when taking sedatives such as benzodiazepines or opioid painkillers such as morphine. This causes the person to become agitated when the medication is supposed to be calming.

Drugs for depression, such as venlafaxine or lithium, as well as cortisone-like agents, can also lead to agitation. This is especially the case when they are overdosed. Occasionally, agitation is also observed after surgery as a side effect of the anaesthesia.

Agitation: Convey calm and security

When dealing with an agitated person, remaining calm and radiating composure is essential. This signals that help is possible because their condition is usually highly frightening for those affected. Create a quiet situation and eliminate disturbing stimuli. It may be helpful to ask other people out of the room.

However, if the affected person shows aggressive behaviour and thus poses a possible danger to themselves or others, you should not hesitate to call the emergency services. In the event of severe agitation, it may be necessary for the patient to be treated with sedatives (benzodiazepines). In severe cases, a referral to a psychiatric clinic takes place to avert danger to oneself or others.

But even if the affected person calms down and the agitation subsides, a state of agitation should always be clarified by a doctor or psychotherapist to discover the underlying cause.

 

Increased risk of injury in dementia

Dealing with agitation in people with dementia is particularly difficult. On the one hand, those affected are usually unable to grasp the situation due to their limited mental abilities, which makes it challenging to have a calming conversation. On the other hand, with such restlessness, which also often occurs at night, there is an increased risk of injury and falling for the person himself.

Treating agitation with sedatives also carries an increased risk in older people with dementia because these drugs further limit motor and mental abilities. Fragrances and soothing music can be used as a valuable supplement to drug therapy.