Agitated depression is a controversial condition that is difficult to diagnose and treat. Symptoms include irritability, restlessness, and difficulty articulating what is wrong. Treatment options include antidepressants and mood-stabilizing medication, but finding the right combination can be challenging. Compliance with medical advice can also be difficult, and care partners may be needed. The condition occurs more frequently in middle-aged people and requires ongoing medication management and therapy.
Agitated depression is a condition with a range of symptoms that are easy to recognize. More at issue is trying to describe how this disease fits diagnostically, especially when it comes to making treatment recommendations. It is often described as depression with some hypomanic symptoms, but whether this makes the illness closer to a bipolar state or a depressive state is highly controversial. The reason people dispute this point is because treating depression and bipolar disorders are not the same thing, and trying to understand the underlying cause of agitated depression could go a long way in determining the best treatment.
As far as symptoms are concerned, the person with this condition is less likely to seem melancholic and more prone to being very irritable or disturbed. People may do things such as yell at others easily, pace the floor, pinch or tug at skin, hair, or clothing, experience considerable restlessness with an inability to sit up for any length of time, and may have difficulty articulate what is wrong. This extreme restlessness may explain, in part, manifestations of significant irritation with others. The person experiencing this condition is driven from within and in a state of severe mental distress.
Usually, these symptoms need to last for several days for the disorder to be considered true agitated depression, and very often they do, making the diagnosis quite easy. What is not so easy is determining the type of treatment. Some doctors learn to prescribe antidepressants to treat the “depressive state,” and others find the disorder much closer to bipolar II, deserving of mood-stabilizing treatment. In both treatment pathways, additional medications may be considered, including anti-anxiety medications such as benzodiazepines, atypical antipsychotics, such as quetiapine or aripiprazole, and potentially others.
The reason the treatment of agitated depression is so hotly debated is because antidepressants can cause hypomania, which may be fueling the disorder instead of helping to calm it. Additionally, some of the atypical antipsychotics are linked to the creation of akathisia, a deep feeling of inner restlessness that can mimic the very symptoms of agitation. Therefore, treatment is challenging and not all doctors will agree on the most appropriate course.
Another obstacle to treating the condition may be that people with agitated depression are not always able to comply with medical advice. Until the condition resolves, which may take some time before the appropriate medications are found, appealing to reason may be an unsuccessful course. More care may be needed until symptoms subside. This could mean hospitalization or it could mean a family member or friend becoming a care partner to ensure medical compliance. This can be difficult for the caretaker because people in this state can be angry, hurtful, or constantly irritable and defiant.
Agitated depression is often called one of the worst forms of depression and occurs more frequently in middle-aged people. When this condition occurs in the elderly, more care should be taken to avoid certain types of medications that are at a high risk of causing death in the elderly. Medication management issues present an additional challenge here, and some medications, including most atypical antipsychotics, cannot be used to relieve hypomanic symptoms.
In all cases, doctors look for a combination of drugs that prove effective and are well tolerated. Once patients have recovered from the acute phase of this disease, they still need to continue taking their prescribed medications. It is also recommended that people with this condition start therapy when they recover from the agitated state. Psychopharmacological therapy and management are useful tools when combined.
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