Agitated Depression

It’s quite common to associate depression with state of low energy and slow physical or mental activity. Well, it is not always the case and Depression may manifest itself in form of physical and emotional agitation.

Agitated state of depression is basically a type of major depressive disorder that is characterized by physical and emotional restlessness, insomnia, and irritable mood.

The patients with agitated depression are driven by hypomania. They experience episodes of anger, agitation and irritability. Another name for agitated depression is mixed mania. Agitation is specifically severe in agitated depression patients.

Diagnostic Criteria for Agitated Depression

A psychiatrist does the diagnosis of agitated depression after carefully evaluating the symptoms of the patient. In some cases, agitation may also result from other severe cases of depression.

According to the Diagnostic criteria of Statistical Manual of Mental Disorders (DSM-IV), a patient is said to have agitated depression in case he/she meets both the following criteria.

  • Major depressive episode
  • Any two of the following manic episodes
  • Motor agitation
  • Psychic agitation
  • Racing thoughts

Forms of Agitated Depression

The agitated depression comprises of following three major forms.

  • Psychotic Agitated Depression (Severe form of melancholia)
  • Non-psychotic Agitated Depression (moderate form of agitation)
  • Excited Agitated Depression (Patient feels racing thoughts)

Treatment of Agitated Depression

The psychiatrists usually recommend the combination therapy including Psychotherapy and Medicines for treating agitated depression.

  • Psychotherapy involves imparting anger management skills and relaxing techniques to the patients.
  • Medication comprises of following medicines.
  • Mood stabilizers such as valproic acid and lamotrigine
  • Atypical antipsychotics such as olanzapine, ziprasidone and aripirizole

Psychotic depression

Hallucinations and delusions may be experienced by depressed patient in severe cases. Such form of depression is called as Psychotic depression that is characterised by severe depressive illness with co-existing psychosis.

Psychotic depression may be seen in patients hospitalised for depression. The psychosis may manifest in form of hallucinations, delusions, or unrealistic experiences. It is more common in patients suffering from schizophrenia.

Patients may see or hear imaginary sounds, voices and visuals. Unlike the manic depressive episodes, the hallucinations in psychotic depression are not “positive” and patient complains of frightening sounds and images.

Symptoms of Psychotic Depression

Patients with psychotic depression may present following symptoms.

  • Intellectual impairment
  • Physical immobility
  • Agitation
  • Insomnia
  • Anxiety
  • Psychosis
  • Constipation
  • Hypochondria

Treatment of Psychotic Depression

The treatment for psychotic depression is done by experienced psychiatrists in the hospital.

Medications used for treating psychotic depression include combinations of antidepressants and antipsychotic medications.

Common Antipsychotic/ Neuroleptic drugs are quetiapine, ziprasidone, risperidone, and olanzapine.

These affect neurotransmitters and are better tolerated than earlier antipsychotics drugs.

The antipsychotic medications are usually effective and patients are usually recovered within a year. In some cases, psychiatrists may recommend electroconvulsive therapy (ECT) for those patients who do not respond to medications.

As the psychotic depression is a serious disease, it is imperative for the patients to work closely with the doctors so that doctors can prescribe most effective drugs with minimum side effects.