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What Is Agitated Depression?

Medically Reviewed by Neha Pathak, MD on July 08, 2021

In recent years, experts have been learning more about agitated depression (AD), which is a type of depression that may involve a depressed mood, psychomotor agitation, and flight of ideas.

Not all experts agree on how to define and classify agitated depression.

Some believe it’s a symptom or feature of another medical condition or mood disorder, like depression or bipolar disorder. Others think it may be a mixed state or part of severe anxiety. Some classify AD as an episode of major depression with psychomotor agitation.

More studies are needed to define and understand it better.

What Agitation Looks Like

Agitation is a sense of uneasiness or restlessness that may include a lot of talking or body motions like pacing or hand-wringing.

Early signs of agitation include:

  • Clenching your fists
  • Outbursts
  • Picking or pulling at your hair, skin, or clothes
  • Shuffling your feet
  • Unconscious movement
  • Uneasiness

Signs that agitation is escalating include:

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

If you have a mood disorder and it’s not being treated effectively, you may have a higher risk of agitation. Common triggers of agitation include stress and traumatic events.

Agitated Depression vs. Depression

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

In a recent study, one-quarter of people with AD 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 AD had longer recovery times than people with nonagitated depression. Their episodes also lasted longer.

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

Who’s at Risk

Recent studies suggest AD 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 one-quarter. 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.

You may also have AD if you have clinical depression or panic disorder. The same study found that agitated depression was linked with depressive symptoms, panic disorder, and suicidal behavior.

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

Treating Agitated Depression

If you have AD, 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:

Doctors are trying to understand which treatments are best for AD. Antidepressants, which doctors often prescribe for depression, may make you more agitated. They may also trigger the type of agitation that leads to suicide.

It’s possible that anti-psychotics, 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, but monitor you closely.

Electroconvulsive therapy may also be an effective treatment for AD.

When to See Your Doctor

If you have AD, it’s important to see your doctor as soon as you see signs of agitation.

Early intervention for agitation is most effective. Your doctor may recommend looking for early signs of an agitation episode so you can treat it before it gets worse.

It’s especially important to treat agitated depression as soon as possible because it’s linked to suicidal behavior.

WebMD Medical Reference

Sources

SOURCES:

The American Journal of Psychiatry: “Agitated Depression in Bipolar I Disorder: Prevalence, Phenomenology, and Outcome.”

Annals of Clinical Psychiatry: “Agitated Depression: Unipolar? Bipolar? or Both?”

Annals of General Psychiatry: “Agitated and mixed depression.”

Bipolar Disorders: “Agitated depression in bipolar disorder.”

Depression and Bipolar Support Alliance: “Understanding Agitation.”

Mayo Clinic: “Depression (Major Depressive Disorder).”

National Alliance on Mental Illness: “Depression.”

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