Agitated Depressive Disorder

Agitated Depression a state of clinical depression in which the person exhibits irritability and restlessness. This term is applied to depressive disorders in which agitation is prominent. Agitation occurs in many severe depressive disorders but in agitated depression, it is particularly severe. Agitated depression is seen more commonly among the middle aged and elderly than among younger patients. However, there is no reason to suppose that agitated depression differs in other impotent ways from the other depressive disorders.



Definition of Agitated Depression

A major depression with agitation that may be driven by hypomania.
Although many people experience symptoms such as feeling slowed down and lethargic when they are depressed, others may experience just the opposite. They may feel anger, agitation and irritability. This is what "agitated depression" refers to.

Agitated depression was once called melancholia agitata. It is now also known as mixed mania.

Agitation occurs in many severe depressive disorders, but in agitated depression it is particularly severe. There is no reason to suppose that agitated depression differs in other important respects from other depressive disorders.

Diagnostic Criteria for Agitated Depression

  • Major Depressive Episode
  • At least two of the following symptoms:
    • Motor agitation
    • Psychic agitation or intense inner tension
    • Racing or crowded thoughts
Agitated depression meets the criteria for major depressive episode but not those of a mixed bipolar disorder according to the DSM-III-R.



Agitated Major Depressive Disorder Symptoms

It is not tough to identify the symptoms of agitated depression. People that suffer from this type of depression are not able to sit still and keep on restlessly moving here and there all the time. It is due to the outburst of emotional energy caused because of agitated depression. Those that suffer from this type of depression tend to complain a lot and develop the feelings of being misunderstood by others. At least 2 of the following manifestations of psychomotor retardation (not more subjective anxiety) are required for several days during the current episode:
  • Tearing of cloths
  • Motor agitation
  • Intense inner tension
  • Racing thoughts
  • Never ending baseless thoughts
  • Continuous talking
  • Hand wringing
  • Pacing
  • Pulling or rubbing on hair, skin, or clothing
  • Outbursts of complaining or shouting
  • Difficulty in explaining problem

Agitated depression in bipolar I disorder

The occurrence of agitated depression in bipolar I disorder is not rare and has significant prognostic and therapeutic implications. Whether the co-occurrence of a major depressive syndrome with one or two of these symptomatic clusters makes up a "mixed state" remains unclear.

Clinical Forms of Agitated Depression

  1. Psychotic agitated depression
    Proposed name: Melancholia
  2. Non-psychotic agitated depression
    Meets the RDC criteria
  3. Excites anxious depression
    Provisional name: Psychic agitation and racing or crowded thoughts.


Complications for Agitated depression

The complications that have been mentioned in various sources for Agitated depression includes getting involved in risky activities, dysfunction in family and work, and even suicide or homicide.

Treatment

Agitated depression can be difficult to treat because the behavior patterns associated with this form of depression lend to the inability to consistently take medication. It is important to get properly diagnosed by a mental health care professional who can supervise your treatment closely. Psychotherapy is also useful in treating agitated depression. It is usually necessary to have long term treatment as a combination drug and psychotherapy. The drug therapy has to be fine tuned to your specific needs. This can take up to a month to see results and a cessation of side effects in most people but it is highly effective.

The common treatment approaches are:
  1. Medicines - Antidepressants and anticonvulsant like divalproex, aripiprazole, clozapine or olanzapine is largely used in treatment of agitated depression.
  2. Psychotherapy - In most of the cases psychotherapy is preferred to treat agitated depression.
  3. Combination of medicines and psychotherapy - When drug therapy and psychotherapy is used in combination then effect is much better for curing agitated depression.
  4. Electroconvulsive therapy - Electricity is passed to the brain through electrodes to overcome from agitated depression.


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