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  • Mental Health Issues
    • Anxiety
    • ADHD
    • Bipolar Disorder
    • Depression
    • Grief
    • OCD
    • Personality Disorders
    • PTSD
  • Relationships
    • Dating
    • Marriage
    • Sex & Intimacy
    • Infidelity
    • Relationships 101
  • Wellness
    • Anger
    • Burnout
    • Stress
    • Sleep
    • Meditation
    • Mindfulness
    • Yoga
  • Therapy
    • Starting Therapy
    • Types of Therapy
    • Best Online Therapy Services
    • Online Couples Therapy
    • Online Therapy for Teens
  • Medication
    • Anxiety Medication
    • Depression Medication
    • ADHD Medication
    • Best Online Psychiatrist Options
  • My Mental Health
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  • What Is Depression?What Is Depression?
  • What Is Agitated Depression?What Is Agitated Depression?
  • SymptomsSymptoms
  • CausesCauses
  • TreatmentTreatment
  • How to DealHow to Deal
  • ConclusionConclusion
  • InfographicsInfographics

Agitated Depression: Definition, Symptoms, & Treatment

Headshot of Natalie Fraize, LMHC, LPC

Written by: Natalie Fraize, LMHC, LPC

Rajy Abulhosn, MD

Reviewed by: Rajy Abulhosn, MD

Published: February 23, 2023

Agitated depression is characterized by intense psychic conflict, distress, irritability, mood swings, and an increase in risky behavior.1 It is more difficult to treat than regular depression and the complexity of the presentation may result in misdiagnosis. With the right treatment, usually a combination of therapy and medication, relief from symptoms is possible.

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What Is Depression?

Depression is a disorder that involves a low mood and influences someone’s energy, motivation, level of irritability, and general well-being. The type of depression someone has influences their symptoms, triggers, and the duration of their low mood.

What Is Agitated Depression?

Agitated depression includes symptoms like depression & anger and restlessness vs. sadness and hopelessness that are usually more typical of depression. It is often seen in people who experience depression & anxiety together. Agitation itself is a non-specific symptom that can be associated with mania, hypomania, anxiety, depression, schizophrenia, borderline personality disorder, and substance use.2

While the DSM-5 does not list agitated depression as a diagnosis, it seems to best fit under the category of a major depressive episode with mixed features. This means that in addition to depressive symptoms, at least three manic or hypomanic symptoms are present most of the time. A major depressive episode with mixed features may occur as a part of major depressive, bipolar I, or bipolar II disorder.

Alex Dimitriu, MD, Silicon Psych“Agitated depression is not an official DSM diagnosis – in my work I look at agitated depression as something more than depression alone. The immediate consideration is always bipolar disorder. More recently I am also finding that ADHD can lead to quite a lot of intensity and volatility, and so can anxiety. The main difference between all of these is the timing or duration of the ups and downs – anxious and ADHD people tend to experience moods of shorter duration, often less than a day, while bipolar tends to be days or weeks.” – Alex Dimitriu, MD at Menlo Park Psychiatry & Sleep Medicine

Agitated Depression Symptoms

Agitated depression includes more regular depression symptoms as well as symptoms of hypo/mania, including excited and over-active behavior and increased participation in risky behaviors. These symptoms of hypo/mania, however, are without the euphoria that may be present in a typical hypomanic or manic episode when seen in agitated depression.

Someone with agitated depression may experience high levels of distress and is at an increased risk for suicidality. Changes in behavior of the person experiencing symptoms will likely be observable by others.

The most commonly noted symptoms of agitated depression include:3

  • Irritability
  • Anxiety
  • Distractibility
  • Psychomotor agitation
  • Racing/crowded thoughts
  • Initial and middle insomnia
  • Indecisiveness
  • Anger
  • Increased talkativeness
  • Emotional lability/tearfulness
  • Inner tension
  • Rumination
  • Impulsivity
  • Risky behaviors

What Causes Agitated Depression?

While there is not one clear answer as to what causes agitated depression, there are identifiable factors that are linked to agitation and this type of depression. Agitated depression may be caused by internal elements, external elements, or a combination of both.

Potential causes and triggers of agitated depression include:

  • Cultural, environmental, and psychosocial factors4
  • Family history of bipolar disorder1
  • Hormone imbalance
  • Use of antidepressants
  • Substance use
  • Major depression or bipolar disorder
  • Borderline personality disorder, anxiety disorders, or ADHD5
  • Toxic stress
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Treatment Options for Agitated Depression

Everyone’s experience with depression varies, but agitated depression is notably distressing. It is important to explain all your symptoms to your provider because an accurate diagnosis is important for driving appropriate treatment. Typically, knowing how to treat depression involves a combination of therapy and medication.

Therapy

Depression therapy is most effective when the client feels comfortable with their therapist. A therapist will be able to assess your symptoms and work with you to determine the best course of treatment, but therapies such as CBT for depression and dialectical behavioral therapy (DBT) can be used to address symptoms typical of agitated depression.6

It is important to explore your therapy options and various modalities offered, and it can be helpful to use an online therapist directory to begin your search. Check to see if you can schedule consultations with the few therapists that you are most interested in to find out if working together may be a good fit.

Medication

Medication for depression differs from medication to treat agitated depression in that antidepressants appear less effective for a depressive episode with mixed features than pure depression. When treating agitated depression, using an antidepressant alone may worsen symptoms.1 If you notice new or worsening agitation, restlessness, or thoughts of suicide after beginning antidepressants, talk to your prescriber immediately or reach out to the national suicide prevention lifeline – 800-273-8255.

There is some evidence that mood stabilizers and atypical antipsychotic medications alone or in combination with antidepressants may be beneficial for treating agitated depression.7 Additionally, some research points to the use of small doses of neuroleptics, anticonvulsants, and lithium for treating agitated depression.8

7 Tips to Deal With Agitated Depression

Managing agitated depression can be challenging. Most of the tips below are focused on ways to counter or calm the agitation that you may be experiencing. It will be important for you to try out a few different strategies and then practice the one or two that work best for you. Practicing at least once a day will help you use the skills when you need them most.

Seven tips for coping with agitated depression include:

1. Follow a Screen-Free Bedtime Routine

A consistent sleep schedule is a key factor for improving mental health. Start by getting a bedtime routine that prepares your body and mind for rest. This might include things like taking a bath or shower, reading a book, listening to calming music, and drinking decaffeinated tea while the lights. Once in bed, you should be ready for sleep and not doing things like checking your phone.

2.  Exercise Regularly

Exercise serves many functions related to mental health and overall wellness. It is a great way to manage stress and use up agitated energy. Regular exercise is helpful for improving sleep and mood. Adding 30 minutes of exercise a few days a week is a great goal if you aren’t already active.

3. Cut Out Caffeine & Energy Drinks

This may seem obvious if you’re feeling agitated, but agitated depression can have other symptoms like difficulty concentrating that might result in the use of caffeine or energy drinks. Try cutting these products out for at least a week to see if some of your symptoms subside.

4. Create a Sensory Soothing Toolkit

Identify one thing that is soothing or pleasant for each of your five senses and gather it all in one place so that when you are feeling down or agitated you can engage in self-soothing. Agitated depression can feel very intense, therefore, using a technique that engages all your senses is a good way to ground yourself.

5.  Explore Relaxation Techniques

Look into guided imagery, progressive relaxation, meditation for depression, relaxed breathing exercises, and other grounding techniques. Try them out to determine which you like the best. Practice it at least once a day when you’re not feeling agitated so that you’re ready to use it under stress.

6. Practice Anger Management

If you’re experiencing agitated depression, you may struggle with how to control anger. Basic tips for anger management are to notice when you’re getting angry and remove yourself from the situation if possible. It’s easier to intervene before you reach the peak of your anger. Identify triggers for your anger. Once you begin to notice signs, then you can implement a relaxation technique you’ve been practicing.

7. Engage In Mindfulness

We often avoid being present when we are experiencing discomfort. With agitated depression, you may be focused on pain from the past or worry about the future. Mindfulness will guide you to be present in the current moment and you can find exercises on all kinds of topics including mindful eating and mindfulness for chronic pain.

Final Thoughts on Agitated Depression

Agitated depression is common and you’re not alone in feeling this way. Finding a therapist and a doctor to help you address your symptoms is the best way to get help. Make sure to emphasize all aspects of your experience when speaking with providers so they can make the proper diagnosis and begin appropriate treatment.

Additional Resources

To help our readers take the next step in their mental health journey, Choosing Therapy has partnered with leaders in mental health and wellness. Choosing Therapy is compensated for marketing by the companies included below.

Talk Therapy 

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For Further Reading

  • SAMHSA 
  • National Suicide Prevention
  • Mental Health America
  • National Alliance on Mental Health
  • MentalHealth.gov

Agitated Depression Infographics

What is Agitated Depression? Agitated Depression Symptoms What Causes Agitated Depression?

Tips to Deal with Agitated Depression

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Sources Update History

Choosing Therapy strives to provide our readers with mental health content that is accurate and actionable. We have high standards for what can be cited within our articles. Acceptable sources include government agencies, universities and colleges, scholarly journals, industry and professional associations, and other high-integrity sources of mental health journalism. Learn more by reviewing our full editorial policy.

  • Akiskal, H. S., Benazzi, F., Perugi, G., & Rihmer, Z. (2005). Agitated “unipolar” depression re-conceptualized as a depressive mixed state: Implications for the antidepressant-suicide controversy. Journal of Affective Disorders, 85(3), 245–258. https://doi.org/10.1016/j.jad.2004.12.004

  • Targum, S. D., & Nierenberg, A. (2011). The complexity of “mixed” depression: a common clinical presentation. Innovations in clinical neuroscience, 8(6), 38–42. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3140897/

  • Stahl, S. M., Morrissette, D. A., Faedda, G., Fava, M., Goldberg, J. F., Keck, P. E., Lee, Y., Malhi, G., Marangoni, C., McElroy, S. L., Ostacher, M., Rosenblat, J. D., Solé, E., Suppes, T., Takeshima, M., Thase, M. E., Vieta, E., Young, A., Zimmerman, M., & McIntyre, R. S. (2017). Guidelines for the recognition and management of mixed depression. CNS Spectrums, 22(2), 203–219. https://doi.org/10.1017/s1092852917000165

  • Park, Y.-M. (2018). The mixed-features specifier of major depressive disorder in DSM-5: Is it practical? Psychiatry Investigation, 15(11), 1009–1010. https://doi.org/10.30773/pi.2018.11.10

  • Chris Aiken, M. D. (2020, November 16). How to diagnose mixed features without overdiagnosing bipolar. Psychiatric Times. Retrieved March 30, 2022, from https://www.psychiatrictimes.com/view/how-diagnose-mixed-features-without-over-diagnosing-bipolar

  • Panos, P. T., Jackson, J. W., Hasan, O., & Panos, A. (2014). Meta-Analysis and Systematic Review Assessing the Efficacy of Dialectical Behavior Therapy (DBT). Research on Social Work Practice, 24(2), 213–223. https://doi.org/10.1177/1049731513503047

  • Shim, I. H., Bahk, W.-M., Woo, Y. S., & Yoon, B.-H. (2018). Pharmacological treatment of major depressive episodes with mixed features: A systematic review. Clinical Psychopharmacology and Neuroscience 16(4), 376–382. https://doi.org/10.9758/cpn.2018.16.4.376

  • Koukopoulos, A., Faedda, G., Proietti, R., D’Amico, S., de Pisa, E., & Simonetto, C. (1992). Un syndrome dépressif mixte [Mixed depressive syndrome]. L’Encephale, 18 Spec No 1, 19–21.

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We regularly update the articles on ChoosingTherapy.com to ensure we continue to reflect scientific consensus on the topics we cover, to incorporate new research into our articles, and to better answer our audience’s questions. When our content undergoes a significant revision, we summarize the changes that were made and the date on which they occurred. We also record the authors and medical reviewers who contributed to previous versions of the article. Read more about our editorial policies here.

February 23, 2023
Author: No Change
Reviewer: No Change
Primary Changes: Updated for readability and clarity. Reviewed and added relevant resources.
May 4, 2022
Author: Natalie Fraize, LMHC, LPC
Reviewer: Rajy Abulhosn, MD
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  • What Is Depression?What Is Depression?
  • What Is Agitated Depression?What Is Agitated Depression?
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