Agitation: Causes and How to Respond

What agitation looks like

Agitation combines physical restlessness with emotional tension. Signs include:

• pacing, fidgeting, wringing hands, being unable to sit still
• fast or pressured speech, shouting or repeated questions
• irritability, snapping at others, low frustration tolerance
• pulling at clothes, lines or bedding
• resisting care, or physical aggression in severe cases

Doctors call purposeless restless movement driven by inner tension psychomotor agitation. It is a feature of anxiety, depression and mania.

Causes of agitation

Everyday triggers

Stress, pain, hunger, heat, noise, lack of sleep, too much caffeine or energy drinks, and frustration can all cause brief agitation that settles once the trigger passes.

Medical causes

Mental health conditions

• Anxiety disorders and panic: restlessness, a racing heart, worry. See generalized anxiety disorder.
• Agitated depression: low mood with restlessness, hand-wringing and poor sleep.
• Mania in bipolar disorder: little need for sleep, racing thoughts, irritability and impulsive behavior.
• Psychosis: hallucinations or fixed false beliefs that make the person feel threatened.
• PTSD: irritability, hypervigilance and outbursts.
• ADHD and autism: restlessness, and distress with sensory overload or changes in routine.

Agitation in older adults and dementia

Agitation in the elderly is often the first sign of an illness such as a urinary infection, pneumonia or dehydration, or a medicine side effect. In dementia, agitation is common and is often triggered by pain, unmet needs (toilet, hunger, thirst), unfamiliar surroundings, overstimulation, or fatigue in the late afternoon (sundowning). A sudden change on top of dementia should always be treated as possible delirium.

How doctors assess agitation

The first priority is safety, then finding a reversible cause. Clinicians will:

• check vital signs, oxygen level, blood sugar and temperature
• ask about the timeline, medicines, alcohol and drug use, recent illness and mental health history
• examine for infection, pain, dehydration, a full bladder or neurological signs
• order tests as needed: blood count, electrolytes, kidney, liver and thyroid function, urine tests, drug screen, ECG, and brain imaging if there is a head injury or new neurological signs

How to help someone who is agitated

De-escalation

• Stay calm, speak slowly and quietly, and use simple sentences.
• Give them space. Stand at an angle, not face to face, and keep an exit clear for both of you.
• Acknowledge their feelings ("I can see you're upset") rather than arguing.
• Reduce noise, lights and the number of people in the room.
• Offer simple choices, water, or help with obvious needs such as the toilet or pain.
• Do not restrain or corner the person unless there is immediate danger. Call for help instead.

For dementia

• Keep routines predictable, with daylight activity and a calm evening.
• Check for pain, constipation, hunger, thirst, and hearing or vision problems.
• Redirect to a familiar, pleasant activity, music or a walk.
• Ask a doctor to review medicines that can worsen confusion.

Medical treatment

Treatment targets the cause: antibiotics for infection, sugar for hypoglycemia, structured treatment for withdrawal, adjusting medicines, or treating mania, psychosis or anxiety. When agitation is severe and dangerous, clinicians may use calming medicines, choosing them carefully because some worsen delirium or increase risks in older people with dementia.

Frequently asked questions

What causes sudden agitation?

Sudden agitation is often caused by delirium from an infection, dehydration or medicines, low blood sugar, low oxygen, alcohol or drug withdrawal, intoxication, or a head injury. In mental health conditions, it can mark a panic attack, mania or psychosis. New agitation with confusion needs urgent medical review.

Why are elderly people agitated?

In older adults, agitation is often a sign of a physical problem: infection, pain, constipation, urinary retention, dehydration or medicine side effects. Dementia also causes agitation, especially in the late afternoon. A sudden change from someone's usual behavior should be checked for delirium.

What is the difference between agitation and anxiety?

Anxiety is a feeling of worry or fear. Agitation is a state of restless, tense behavior that others can see. Anxiety can cause agitation, but so can pain, delirium, mania, withdrawal and many medical conditions.

What is psychomotor agitation?

Psychomotor agitation is purposeless physical activity driven by inner tension, such as pacing, fidgeting and hand-wringing. It is common in anxiety, agitated depression, mania and withdrawal states. It is one of the symptoms doctors look for when diagnosing depression.

How do you calm an agitated person?

Stay calm, speak softly, give them space, reduce noise and lights, acknowledge their feelings and offer simple choices. Check for unmet needs such as pain, hunger or the toilet. Do not argue or restrain them. If anyone is at risk of harm, call 911.