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Agitated Depression: What Is It and How Is It Treated?

Author Lisa Batten
July 20, 2021

Depression is a condition impacting nearly one-fifth of the population and presenting with a range of different symptoms across a variety of subtypes. Agitated Depression is a term used to describe a subtype of depression characterized by agitation and exhibiting symptoms such as irritability, restlessness, and anxiety during a depressive episode.[1][2]

sad irritated woman sitting in car

In a clinical setting, agitated depression is generally referred to as major depressive disorder (MDD) with mixed features. Agitated depression may also be referred to as mixed mania, depression with psychomotor agitation, or mixed episode depression. Diagnosing agitated depression is not always straightforward since the symptoms overlap with other conditions and types of depression.[3]

Generally, a person with agitated depression experiences many of the typical symptoms of depression such as hopelessness and apathy. However, they may also experience volatility in their mood and behaviors, often expressed in a short temper, outbursts, racing thoughts, and acting out.

Symptoms of Agitated Depression

In general, the symptoms of agitated depression vary in their presentation from person to person. Agitated depression is always characterized by core symptoms of MDD along with symptoms of agitation. The episode of MDD should occur at the same time as the features of agitation in order to be classified as agitated depression.

Core symptoms of MDD may include:

  • Feeling sad, down, or hopeless
  • Irritability
  • Changes in sleeping patterns (too much or too little)
  • Changes in weight and/or appetite
  • Low energy and feeling tired easily
  • Cognitive difficulties (memory, focus, decision making)
  • Thoughts or talk about ending one’s life

Symptoms of agitated features may include:

  • Extreme irritability (short-tempered and lashing out)
  • Anger
  • Anxiety and tension
  • Disruptive or impulsive behavior
  • Excessive complaining
  • Fidgeting or pacing
  • Incessant talking
  • Nail biting, hand wringing, and/or clenching fists
  • Picking at skin, clothing, and/or hair
  • Racing thoughts
  • Restlessness, pacing, or excessive movement
  • Shouting

There are unique differences between individuals in how symptoms present and the impact they have on their daily lives. Symptoms of agitated depression can appear suddenly or build gradually over time.[2]

Causes of Agitated Depression

Like other mental health conditions, agitated depression has no one root cause. It is thought to arise from a combination of genes, brain chemistry, history of trauma, environmental factors, and comorbid health conditions.[4]

Some common risk factors for developing agitated depression include:

  • Traumatic events
  • Dysfunctional family life
  • Long-term stress
  • Feelings of loss
  • Not feeling in control and/or feeling inferior

Certain mental health and medical conditions may elevate a person’s risk of agitated depression or further contribute to symptoms.[3]

Comorbid mental health conditions contributing to agitated depression include:

  • Bipolar disorder
  • Anxiety disorders
  • Attention deficit and Hyperactivity Disorder (ADHD)
  • Substance abuse disorders

Medical conditions that may cause or contribute to agitated depression include:

  • Hormonal imbalances
  • Hypothyroidism
  • Dementia

In some cases, agitated depression can be the result of side effects from medications or other substances. Even certain medications for depression can lead to agitated symptoms in some people. Talk to your doctor immediately if you experience significant agitation after starting a new medication.

Agitated Depression Treatments

There are a variety of treatment approaches that are effective for agitated depression. Ideally, treatment will include a combination of medication, talk therapy, and lifestyle changes.

Medications

Once you have been diagnosed as having MDD with agitation your doctor may prescribe medication to help reduce the symptoms of both depression and agitation. Commonly prescribed medications include antidepressants, anti-anxiety, or sedative medications, and/or mood stabilizers.

Your doctor may prescribe a single medication or a combination of medications, known as dual therapy or augmentation therapy. It is common for treating physicians to test several different compounds and doses in order to find what works best for reducing the symptoms of agitated depression.

Medications must be prescribed with care when treating agitated depression as some individuals may experience a worsening of agitation with some compounds.[5]

Talk Therapy

Psychotherapy, or talk therapy, can be an excellent part of a treatment plan for people experiencing agitation with their depression. Talk therapy focuses on working through many of the symptoms, identifying triggers, and strengthening coping mechanisms. Your therapist will also work with you to use strategies to de-escalate and find calmness when feeling overwhelmed or angry.

Cognitive behavioral therapy (CBT) has been shown to be effective in reducing symptoms of MDD and agitation.[6] This type of therapy works on talking through problems and feelings while learning how to change thoughts and behaviors. CBT helps people feel more in control of their reactions to emotions, thoughts, and difficult situations.

There are many different types of therapy, such as group therapy, dialectical behavior therapy, or interpersonal therapy that may also be effective. It is crucial to find a therapist you enjoy working with in order to optimize your progress in talk therapy. Finding a space that’s calming is very important to treatment when agitation is a key symptom.

Lifestyle Changes

Positive lifestyle changes can be implemented as part of a treatment plan to reduce symptoms and help to improve the quality of life in people with agitated depression. Finding ways to alleviate stress and frustration such as taking walks and talking to trusted loved ones can be very helpful.

Regular exercise (30-60 mins five times a week) and choosing healthier whole foods can help improve overall well-being. Additionally, implementing a daily meditation practice and breathwork techniques (i.e. diaphragmatic breathing) can significantly help with de-escalation, stress management, and controlling outbursts and feelings of irritability.

People who experience significant agitation should also make an attempt to be mindful of habits that can escalate symptoms, such as drinking alcohol. In certain cases, it may be best to avoid such habits until symptoms are better controlled.

Conclusion

Living with agitated depression can be difficult and certain aspects of symptoms may be confusing. Getting a diagnosis is an important first step toward determining an effective treatment plan for agitated depression. Given that the presentation of symptoms is unique for each individual, treatment plans will also be unique.

Many people with agitated depression may also be experiencing strained relationships and interpersonal conflict due to their symptoms, including irritability and anger. Seeking help for these symptoms and opening up to loved ones about struggles can be extremely helpful for getting interpersonal support during treatment. 

Do not be afraid to reach out for help if you are experiencing symptoms of agitated depression that are interfering with your quality of life. You should always seek the expert opinion of a mental health professional who can guide you on an appropriate treatment plan based on your symptoms. In addition to talk therapy, medications, and lifestyle changes, you can also help alleviate symptoms by surrounding yourself with friends and family, or by joining a support group.


References

  1. Anxiety and Depression Association of America. (2021). Facts & Statistics | Anxiety and Depression Association of America, ADAA. ADAA. https://adaa.org/understanding-anxiety/facts-statistics
  2. Benazzi F. (2004). Agitated depression: a valid depression subtype?. Progress in neuro-psychopharmacology & biological psychiatry, 28(8), 1279–1285. https://doi.org/10.1016/j.pnpbp.2004.06.018
  3. Verdolini, N., Agius, M., Ferranti, L., Moretti, P., Piselli, M., & Quartesan, R. (2015). The State of the Art of the DSM-5 “with Mixed Features” Specifier. TheScientificWorldJournal, 2015, 757258. https://doi.org/10.1155/2015/757258
  4. The National Institute of Mental Health Information Resource Center. (2021, July 20). NIMH » Depression. NIMH. https://www.nimh.nih.gov/health/topics/depression/
  5. Koukopoulos, A., & Koukopoulos, A. (1999). Agitated depression as a mixed state and the problem of melancholiaThe Psychiatric clinics of North America22(3), 547–564. https://doi.org/10.1016/s0193-953x(05)70095-2
  6. Lehner-Adam, I., & Dudas, B. (2013). Cognitive Behavioral Therapy (CBT) of Depressive Disorders. Mood Disorders. Published. https://doi.org/10.5772/54200
Author Lisa Batten

Dr. Lisa Batten has a master’s degree in clinical psychology and a Ph.D. in developmental psychology. She has over a decade of experience in clinical research and specializes in writing about mental health, wellness, nutrition, and fitness.