What Is Major Depression With Agitation?

Major depression with agitation, referred to as agitated depression, is generally considered to be present when a person has a depression that includes at least two of the following symptoms: motor agitation; psychic agitation or intense anxiety; or racing or crowded thoughts.

Agitated Depression vs. Mixed States Depression

• Agitated depression (AD) can be distinguished from mixed state depression (MXD), sometimes referred to as hypomanic depression. Mixed state depression is a form of depression marked by the simultaneous presence of both manic and depressed symptoms. Mixed state depression may or may not include agitation, but will also include other symptoms of mania, including decreased need for sleep, high energy, euphoria, intrusive behavior and manic delusions.

Co-occurrence of Agitated Depression and MXD

• Depending on the study, between 40 percent and 80 percent of patients with agitated depression also meet the diagnostic criteria for mixed state depression.

Co-occuring Conditions

• Agitated depression occurs more frequently among people with bipolar disorder, the elderly, and persons with dementia or psychotic symptoms. Psychotic symptoms that can co-occur with agitated depression include hallucinations (seeing or hearing things that aren’t there) or delusions associated with the manic and depressive poles of bipolar disorder (grandiosity or worthlessness).

Treatment

• Medication treatment is by mood-stabilizing medications such as lithium and carbamazepine sometimes accompanied by anti-depressants or neuroleptic medications such as divalproex, aripiprazole, clozapine or olanzapine. Therapy is also effective, but a combination of therapy and medication together has been found to be the most effective treatment.

Implications

• People with agitated depression are at a higher risk for suicide than people who have depression without agitation. Depressive episodes may be less frequent, but they seem to last longer.