What is Agitated Depression?


Agitated depression is a type of depression that involves symptoms like restlessness and anger. People who experience this type of depression usually don’t feel lethargic or slowed-down.

Agitated depression used to be called “melancholia agitata.” It’s now known as “mixed mania” or “mixed features.” And it can be seen in people with bipolar disorder. But, psychomotor agitation can also be seen in major depressive disorder. This condition makes a person appear restless.

Agitated depression symptoms

Symptoms of agitated depression include:

  • extreme irritability, like snapping at friends and family, or being annoyed at small things
  • anger
  • agitation
  • fidgeting
  • racing thoughts and incessant talking
  • restlessness
  • pacing
  • hand-wringing
  • nail-biting
  • outbursts of complaining or shouting
  • pulling at clothes or hair
  • picking at skin

Some people with major depressive disorder will experience agitation. But the agitation is more severe and persistent in those with agitated depression. This condition can lead to conflicting feelings of intense restlessness and depression. People may also experience feelings of agitation or irritability along with sadness or emptiness.

People with agitated depression may be more likely to be in danger of self- injury and suicidal thoughts and attempts.

Suicide prevention

If you think someone is at immediate risk of self-harm or hurting another person:

  • Call 911 or your local emergency number.
  • Stay with the person until help arrives.
  • Remove any guns, knives, medications, or other things that may cause harm.
  • Listen, but don’t judge, argue, threaten, or yell.

Causes and triggers of agitated depression

Common triggers or causes of agitated depression include:

  • traumatic events
  • long-term stress
  • hormone imbalances
  • hypothyroidism
  • bipolar disorder
  • anxiety disorders

In some cases, depression medications can cause agitated depression. Agitation or excitability may be side effects of medication. Tell your doctor immediately if you experience increased anxiety or irritability after starting a new medication for depression. Your doctor can help find another medication.

How agitated depression is diagnosed

A psychiatrist can diagnose agitated depression. They’ll do this through talk therapy and observing your mannerisms and mood. Your doctor may also order a blood test to rule out other potential causes of irritability, like vitamin deficiencies or hormone imbalances.

Your doctor will also rule out other types of depression and bipolar disorder. Bipolar disorder is often characterized by mood swings and sometimes irritability.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), a diagnosis of agitated depression is based on the following:

  • psychomotor agitation, or physical symptoms of agitation and restlessness
  • racing or crowded thoughts
  • psychic agitation, or intense inner tension

You doctor may diagnosis you with depression first, and agitated depression later.

Agitated depression treatment

Agitated depression is often treated with a combination of treatments that may include:

  • medications
  • therapy
  • electroconvulsive therapy, in extreme cases

Medications can help stabilize your mood. Your therapist may prescribe one or more of the following:

  • antidepressants
  • antianxiety medications
  • mood stabilizers

In many cases, finding the right medication, dosage, or combination of medications will take some time.

Medications must be used carefully in cases of agitated depression. They may have the opposite effect on those with agitated depression than on those with typical depression.


Psychotherapy is an essential part of treating any type of mood disorder. Your therapist can help you identify your triggers. They’ll also help you develop coping mechanisms and habits to help you manage your symptoms.

Cognitive behavioral therapy (CBT) is often used for agitated depression. In CBT, your therapist will have you talk through your problems and feelings. And you’ll work together on changing thoughts and behaviors.

If needed, your therapist may use de-escalation techniques, such as:

  • speaking in a slow, soft voice
  • giving you space
  • offering you a quiet place to calm down

Outlook for agitated depression

Agitated depression is a severe form of depression. It may have a higher likelihood of self-harm or suicidal thoughts and behaviors. It’s important to get treatment as early as possible.

The right treatment can help you manage agitated depression. It’s important to maintain treatment even after you recover from your depressive episode. Taking medications infrequently or not maintaining treatment can cause a relapse. It can also make the next episode of agitated depression more difficult to treat.

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