Agitated depression is unique in that it does not consist of the typical depression symptoms of fatigue and sadness. This type of clinical depression can consist of feelings of irritation, restlessness, anger, insomnia, fidgeting, or racing thoughts. According to Survivingdepression.net, motor agitation might include nervous physical activity such as pacing, hair-pulling, wringing hands, rubbing skin, shouting and incessant talking.
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As with many psychological disorders, symptoms of agitated depression overlap with other disorders, making specific diagnosis sometimes difficult. In fact, there is controversy over whether agitated depression should be a diagnosis of its own or part of another. It is currently classified as a severe type of depression, but some argue that this condition should be used as a subtype of bipolar disorder, characterized by mood swings. This is particularly important for diagnosis as it might dictate the type of treatment to be utilized. A 2004 study by Italian researchers Benazzi, Koukopoulos and Akiskal evaluated 336 patients with a history of depression and agitation. They found that a misdiagnosis of major depression, typically without the presence of mood changes and agitation, instead of a mood disorder could lead to therapy that ignored the presence of the irritability and could even make symptoms worse.
Agitated Depression and Attention Deficit Hyperactivity Disorder
A 2006 paper by Burton Norman Seitler, Ph.D., titled “On the Implications and Consequences of a Neurobiochemical Etiology of Attention Deficit Hyperactive Disorder,” suggests that ADHD actually might be a form of agitated depression. According to Seitler, the Diagnostic and Statistical Manual-IV lists the symptoms of ADD as restlessness, attention problems, fidgeting, self-esteem issues and trouble staying on task. These symptoms mirror those of agitated depression. He says it is 10 times as likely for a boy to be diagnosed than a girl, and explains that agitation and hyperactivity are manifested as a more tolerated social outlet for the expression of negative feelings than crying and sadness. He challenges the theory that ADHD is neurobiological, or a result of chemicals in the brain, instead of a socialized creation. In his work with children exhibiting symptoms of ADHD, he found an overwhelming prevalence of sadness. This theory presents further difficulty in the classification and diagnosis of mental health illnesses involving agitation.
When signs of agitation are present, a physician might request tests including blood samples to rule out vitamin deficiency, hormone imbalance or infection that might cause agitation. Other diagnostic tools consist of X-rays, MRI (magnetic resonance imaging), a spinal tap, urine samples and basic vital signs. Since many other health conditions can cause signs and symptoms of agitation, these tests are used to narrow down the possibilities.
Treatment for agitation depression might consist of traditional anti-depressants, sedatives, antipsychotics, or medications having the reverse affect, as in the treatment of ADD, whereupon the hyperactive patient is given paradoxical stimulants to reduce the agitation. Psychotherapy also is a treatment option, and according to Survivingdepression.net, combining the two is often used in long-term treatment.
Agitated depression can be a result of medications meant to treat depression, making the individual restless and excitable, thus calling for a change in medication. Due to the behavior patterns of agitated depression and depression in general, inconsistency in taking medications is common, making treatment more difficult. Taking medication as directed is the most effective method of finding a treatment that provides relief.
- Surviving Depression: Agitated Depression
- European Psychiatry; “Toward a Validation of a New Definition of Agitated Depression as a Bipolar Mixed State (Mixed Depression); F. Benazzi, A. Koukopoulos and H.S. Akiskal; 2004
- MedlinePlus: Agitation
- Ethical Human Psychology and Psychiatry; “On the Implications and Consequences of a Neurobiochemical Etiology of Attention Deficit Hyperactive Disorder (ADHD)”; Burton Norman Seitler, Ph.D.; 2006