Agitated depression (AD) is a relatively severe type of clinical depression that combines the persistent sadness, pessimism, low energy, and low or “empty” mood of typical depression with agitated symptoms such as irritability, anxiety, restlessness, excessive talking, fidgeting, and/or angry outbursts.
This mental health condition may also be referred to as unipolar, mixed state, mixed features, mixed mania, depression with psychomotor agitation, or mixed episode depression.
At a Glance
Agitated depression can lead to features of depression mixed with symptoms of agitation, restlessness, and anger. Symptoms of the condition can overlap with other types of depression, so diagnosis can sometimes be challenging. Like other forms of depression, a combination of factors, including genetics, brain chemistry, stress, and environmental factors, can contribute to the onset of agitated depression. If you are experiencing symptoms of this condition, effective treatments such as therapy, medication, and lifestyle changes can help.
Understanding Agitated Depression
There are many types of depression which, as a group of mental health disorders, affect over 264 million people of all ages worldwide.1 AD is one way depression manifests.
The diagnosis remains somewhat controversial and inconsistent (for example, some clinicians prefer to use the diagnosis of depression with mixed features or consider it part of bipolar disorder) as the characteristics of the condition overlap with a variety of other types of depression.2
However, researchers and clinicians are increasingly understanding that depression, mania, and mental health, in general, exist on a spectrum, which is why various names may be used to describe a person’s depression and that each person does not necessarily exhibit all of the possible symptoms.3
Generally, a person with agitated depression experiences the intense malaise, lack of energy, hopelessness, and apathy of typical depression as well as an urge to act out, which is often expressed in volatile behavior, insomnia, negative mood, racing thoughts, and a short temper.
While these symptoms may also occur in depression, for those with agitated depression these issues are more pronounced and persistent.
Find out more about causes, risk factors, diagnosis, and treatment of agitated depression below.
Symptoms of Agitated Depression
As stated above, this mental health disorder may be called agitated depression or be classified another way by your mental health provider. However, the usual signs and symptoms of this condition will include some of the typical symptoms of depression, such as:4
- Depressed or low mood
- Fatigue
- Feeling worthless, ashamed, empty, or guilty
- Insomnia or sleeping too much
- Lack of energy, motivation, and interest in things that previously were of interest
- Losing or gaining weight and/or eating more or less than usual
- Pessimism
- Sadness
- Suicidal ideation or attempts
If you or a loved one are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.
For more mental health resources, see our National Helpline Database.
Agitated Symptoms
Additionally, those with agitated depression will also experience some of the following signs and symptoms that define their condition as “agitated:”5
- Anger
- Anxiety
- Being annoyed at little things
- Excessive complaining
- Extreme irritability
- Feeling a need to lash out or act out
- Fidgeting
- Incessant talking
- Nail biting, hand wringing, and/or picking at skin, clothing, and/or hair
- Outbursts
- Racing thoughts
- Restlessness, pacing, or excessive movement
- Shouting
As noted above, each person may have a unique combination of depressive and agitative symptoms that together present as agitated depression.
Diagnosing Agitated Depression
Agitated depression is diagnosed by your doctor, psychiatrist, and/or mental health provider. Your practitioner will review your symptoms and medical history before making their diagnosis.
As noted above, the diagnosis of this disorder is not entirely straightforward as it overlaps with several types of depression. Sometimes, a person is diagnosed with depression first and then agitated depression later, once the nuances of their condition come to light in therapy.
Your mental health provider will carefully evaluate your condition by observing your moods and behavior. They will also take your medical and mental health history and learn more about your experiences in talk therapy in order to distinguish agitated depression from other possible issues, such as bipolar disorder.
For diagnosis, symptoms of the condition are present for at least two weeks and at least two symptoms of physical agitation and/or mental agitation are experienced along with typical symptoms of depression.6
A key component of agitated depression is that, unlike some other mental health conditions where states of agitation, elation, and/or activity come in waves (such as with bipolar disorder), the feelings and behavior of agitation are constant along with the symptoms of depression. The symptoms of agitation are also more extreme and persistent than with other types of depression.
Another facet of agitated depression that mental health providers will evaluate and watch out for is a propensity for substance use disorders, self-harm, and suicidal ideation. It’s important to know that people with this condition are more likely to engage in these harmful thoughts and behaviors.7
What Causes Agitated Depression?
Like many mental health conditions, the causes or triggers of agitated depression are complex and thought to arise from a combination of factors, including heredity, brain chemistry, childhood trauma, emotional distress, environmental factors, comorbid mental health conditions, and other issues.
Some common risk factors and contributing factors for developing agitated depression include the following:8
- Dysfunctional family life
- Feelings of loss
- Feelings of inferiority, regret, and/or worthlessness
- Hormonal imbalances
- Hypothyroidism
- Other mental health conditions, such as bipolar disorder, attention deficit and hyperactivity disorder (ADHD), and anxiety disorders
- Poor coping skills
- Prolonged stress
- Traumatic events
Often, there may be a combination of factors that contribute to the development of this disorder. Sometimes, the causes may not be completely clear.
Additionally, some medications for depression may prompt agitated behaviors in the people who take them, causing the person to develop agitated depression as a result.
Treatments for Agitated Depression
Treatment options for agitated depression are similar to those for other types of depression and usually include talk therapy and medications.
Psychotherapy
Cognitive-behavioral therapy, which seeks to help a person recognize and change negative or destructive thought patterns, is often used to treat this condition.
Medications
Antidepressants, mood stabilizers, and/or anti-anxiety medications are also often used in combination with therapy. Note that it can take time (typically from one to two months or longer) for medications to take effect—and to find the right one for you at the correct dosage.8
ECT
In more severe cases when other treatments are not working, electroconvulsive therapy (ECT) may also be used.
Agitated depression can be challenging to treat, making it very important to stick to your prescribed treatment plan, even when your symptoms seem to be improving and/or you when you are out of a depressive episode.
Coping With Agitated Depression
Know that with treatment, agitated depression can be managed effectively. As noted above, consistent treatment is the best way to find relief from this condition.
Getting care early in your depressive episodes also makes treatment success more likely and effective.
In addition to therapy, where you can work on transforming and taking charge of your thoughts and actions, there are many strategies and skills you can work on to help you cope with this condition, including the following:
- Deescalation techniques
- Disrupting reactivity and other negative habits
- Exercise9
- Getting enough sleep
- Self-calming techniques
- Self-care
- Stress management
What This Means For You
Finding out that you have agitated depression can be upsetting but know that your diagnosis can be the beginning of getting help.
With proper treatment and consistent attention to taking care of your mental health, you can regain—and maintain—control over your life and mental health.