Agitated depression falls under the umbrella of the depression diagnosis. It is a form of depression where the individual is often agitated, restless and angry often.

In the past, agitated depression was known as “melancholia agitata”, but is now referred to as “mixed mania” or “mixed features”.

Agitated depression is often seen in people who are middle-aged and elderly. Younger populations tend to have more melancholic and sad features of depression. However, agitated depression can affect any person.

What Is Agitation?

Being agitated or feeling agitation can manifest in different ways. A person who is agitated will feel a severe sense of uneasiness. He or she may find it difficult to control this restlessness and uneasiness. As a result, they feel discomfort.

There is an inner restlessness that cannot be explained or controlled by the individual. When people are uncomfortable, they tend to have a short temper, uncooperative, and lash out at others.

Being agitated interferes with one’s work and social life. In worse case scenarios, they will hurt others or hurt themselves.

Symptoms of Agitated Depression

In order to be diagnosed with agitated depression, one must experience a depressive episode. Being agitated or irritable is a prominent symptom in agitated depression. A person may be described as “short-tempered”. He or she may “snap” at family or friends easily. Small things tend to annoy them.

A person with agitated depression will have outbursts and poor impulse control. This individual will be easily upset or angered whether they are big or small problems. Controlling their reactions and emotions are harder when having agitated depression.

BFRBs

Hair pulling, nail biting and skin picking are common symptoms of agitated depression. Nail biting and skin picking fall under the umbrella of body-focused repetitive behaviors (BFRBs).

Skin picking

Skin picking is known as excoriation in the medical field. This occurs when a person repetitively picks, rubs, scratches, or digs at his or her own skin. Some people pick at their skin as a form of relief with agitated depression.

This act can be relieving to the person who is currently uncomfortable or agitated. It may also be a way to distract their thoughts. However, picking at one’s skin can result in skin discoloration, scarring, and damage to the skin.

Nail biting

Excessive nail biting over time causes damage to one’s fingernails. Nail biting can also cause dental issues, mouth injuries, and infections.

This is because nail biting has the ability to open the skin. From there, numerous bacteria on a person’s hands can travel into to their mouth, and open cuts on the fingers. As a result, infections and viruses can get into the body.

Hair pulling (trichotillomania)

Hair pulling (trichotillomania) is when a person repetitively pulls out hair from their scalp, eyelashes, eyebrows and other body areas. Like with nail biting and skin picking, pulling out hair causes a sense of pleasure and relief to the individual.

On the other hand, pulling out hair can cause permanent damage and scarring. As a result, the hairs will not grow back and can hinder one’s social and work functioning. If a person becomes agitated, they may consciously or automatically start to pick at their skin, bite their nails, or pull out hairs.

In addition, an individual must have two or more of the following symptoms:

Motor agitation

Motor agitation, such as fidgeting, hand-wringing, pacing, etc. is a common symptom found in agitated depression. These actions give the individual a sense of relief, calming, and distraction from their agitation.

Psychic agitation

Psychic agitation or intense inner tension is described as internal conflict or inability to provide relief to oneself. This can manifest in a number of ways, such as irritability, anger, outbursts, excitement, and mania.

Racing thoughts

Racing or crowded thoughts are a common symptom. One’s thoughts will be simple thoughts or ruminating thoughts on the events of the past or present. They can be good or bad, and whatever comes to the person’s mind.

The individual experiencing this will find it hard to control or stop their thoughts from coming up in their consciousness. Because of this, it can be difficult concentrating at school or work.

Falling asleep may also be hard because of incessant thoughts and worries. They may also have a hard time making everyday decisions.

Bipolar Disorder

Agitated depression is commonly seen in people diagnosed with bipolar disorder, but it can also be seen in people who have a major depressive disorder.

In bipolar disorder, agitated depression is seen during the hypomanic state. Hypomania is a symptom seen in the bipolar II diagnosis, where the individual does not reach a full, manic episode. During this time, the individual will experience heightened irritability and will be easily distracted and unable to control their racing thoughts.

Depressive Disorder

Symptoms of agitated depression in major depressive disorder tend to be around not being able to calm oneself down. This individual will pace wring his or her hands, and have difficulty sitting still.

Stress can be a trigger that causes agitation symptoms to appear. Trauma and reminders of a traumatic event are also a trigger for agitated depression.

Treatment

Recognizing the signs of agitation is a good first step in treatment. When a person can recognize the signs, they can take steps to manage the feelings in a healthy manner. Agitated depression can be treated in a number of ways.

Psychotherapy

Psychotherapy is a common treatment for agitated depression and its symptoms. Common psychotherapy interventions include cognitive behavioral therapy and mindfulness. Often times, psychotherapy and medication are combined as a way to treat agitated depression.

Medication

Medication is another treatment option for agitated depression. Selective serotonin reuptake inhibitors (SSRIs) and mood stabilizers have been effective in helping to alleviate agitated depression symptoms.

SSRIs and mood stabilizers have also been shown to work well with the agitation symptoms experienced during depressive episodes. They also help to alleviate other symptoms, such as anxiety, panic disorder symptoms, mania, and PTSD related symptoms.

The downside of SSRIs is they can take 4 to 6 weeks to feel a therapeutic response. This can cause frustration in patients as they look for faster relief from their agitated depression.

Electroconvulsive therapy (ECT)

Electroconvulsive therapy (ECT) is another treatment option for agitated depression. ECT involves administering electrical stimulation to the brain. These electrical currents cause small, brief seizures.

Before undergoing ECT, the patient is given anesthesia and muscle relaxer before the procedure. This procedure is usually used after other treatment options have been used.  If the other treatments have been ineffective, ECT is an option.

Agitated depression is a type of depression that can affect a person’s overall quality and happiness in life. Those diagnosed face a number of daily challenges, as well as a higher risk for self-harming and suicidal thoughts and behaviors.

With proper care and treatment, agitated depression can be managed and significantly improve a person’s quality of life in many aspects.



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