Agitated depression is a condition with a number of easy to recognize symptoms. More at issue is trying to describe how this illness fits in diagnostically, especially when it comes to making treatment recommendations. It’s often described as depression with some hypomanic symptoms, but whether that makes the illness closer to a bipolar state or a depressive state is highly contested. The reason that people take issue on this point is because treatment of depression and bipolar disorders are not the same, and trying to realize the underlying cause of agitated depression could be highly useful in determining best treatment.
As for symptoms, the person with agitated depression is less likely to seem melancholy and more like to be highly irritable or disturbed. People may do things like easily shout at others, pace the floor, pick at or yank at skin, hair or clothes, feel considerable restlessness with an inability to sit for any period of time, and they may have difficulty articulating what is wrong. This extreme restlessness can explain, in part, displays of significant irritation with others. The person experiencing this condition is driven from within and in a state of severe mental discomfort.
Usually, these symptoms must last for several days for the disorder to be considered true agitated depression, and they very often do, making diagnosis somewhat easy. What is not so easy is determining type of treatment. Some doctors learn toward prescribing antidepressants to treat the “depressed state” and others feel the disorder is much closer in proximity to bipolar II, deserving mood stabilizer treatment. Down either treatment path, additional medications could be considered, including anti-anxiety medications like benzodiazepines, atypical antipsychotics, such as quetiapine or aripiprazole, and potentially others.
The reason that treatment of agitated depression is so greatly at issue is because antidepressants may cause hypomania, which might fuel the disorder instead of helping to calm it. Furthermore, some of the atypical antipsychotics are linked to creating akathisia, a profound feeling of inner restlessness that may 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 can be that people with agitated depression aren’t always able to comply with medical directions. Until the condition resolves, which may take time before appropriate medicines are found, appealing to reason could be an unfruitful course. Greater care might be needed until recession of symptoms. This could mean hospitalization or it might mean having a family member or friend become a care partner to guarantee med compliance. This can difficult for the caretaker because people in this state may be angry, insulting or constantly irritable and challenging.
Agitated depression is often called one of the worst forms of depression and it more frequently occurs in people who are at least middle-aged. When this condition occurs in the elderly, more care must be taken to avoid certain types of medications that are at high risk of causing death to seniors. Medication management issues, here, pose an additional challenge, and certain drugs, including most atypical antipsychotics cannot be used to calm hypomanic symptoms.
In all cases, doctors look for a combination of drugs that prove effective and that are well tolerated. Once patients have recovered from the acute phase of this illness, they still need to remain on prescribed drugs. It is also recommended that people with this condition begin therapy when they progress out of the agitated state. Therapy and psychopharmacological management are useful tools when combined.