Agitated Depression: What Is It, Symptoms, Causes & Treatment 2023

Jennifer Olejarz

Updated on - Written by
Medically reviewed by Dr G. Michael DiLeo, MD

agitated depression

When we think of depression we often imagine someone sad and lethargic, hunched over, with no energy to get out of bed in the morning. However, there are many different types of depression that people can easily miss and mistake for chronic stress or even bad behavior. 

While agitated depression isn’t a medical term, it’s used for people suffering from different symptoms[1] of both anxiety and depression. They may carry on with their day normally but frequently display signs of anger, rudeness, and impatience. They may also not show any symptoms but complain of intense inner agitation and psychic pain. This can impact their function, personally, professionally, and societally. 

Luckily, with an effective treatment plan and support, people experiencing agitated depression can recover a balanced mood and outlook on life. 

What Is Agitated Depression?

This mental health condition is characterized as a type of clinical depression and may be confused with bipolar disorder. It’s referred to as mixed depression[2], which is a major depressive disorder (MDD[3]), but with mixed features[4]. It can mean that a person moves between or concurrently experiences mixed states of both manic and depressive symptoms. This includes physical restlessness (psychomotor agitation), anxious distress, mood swings, anger, and irritability. 

Research[4] on agitated depression has been limited, including methods of measuring and diagnosing mixed states. There are also overlapping symptoms with bipolar disorder, making it all the more difficult to diagnose or develop the right treatment plan needed for clinicians. The fact that it’s not an official clinical diagnosis[5] isn’t because it doesn’t exist; it’s because it’s so complex that the medical literature has yet to characterize it succinctly.

Agitated Depression Symptoms

Any type of mental health disorder comes with a wide range of signs and symptoms. Not every person suffering will display the exact same features, but the majority of those with agitated depression will share similar conditions to those with major depressive disorder, such as

  • Fatigue
  • Insomnia or oversleeping
  • Changes in appetite or weight
  • Unexplained aches and pains
  • General sadness or emptiness
  • Little motivation
  • Loss of interest in previously enjoyed activities
  • Highly self-critical (shame, guilt)
  • Low self-worth and self-esteem
  • Unable to find meaning in life
  • Suicidal thoughts or attempts

What specifically makes someone more likely to be classified as agitated depression are symptoms related to anger and impatience, such as

  • Indecisiveness
  • Extreme irritability
  • Continuous complaining
  • Outbursts or temper tantrums
  • Constant anger and frustration
  • Incessant talking or racing thoughts
  • Easily distracted or impulsive
  • Restlessness or excessive movement (nail biting, skin or hair picking, fidgeting)

More than two or three manic symptoms combined with depressive episodes is classified as mixed depression by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). When the mixed features and symptoms come with great lows but aren’t followed by highs, as with typical manic episodes, those suffering are at a higher risk of suicide.

If you or someone you know has several of these symptoms, it’s recommended to contact a mental health professional who not only can offer support, insight, and tools that can lessen the suffering but identify your condition to steer those tools. There are affordable online therapy options available, as well as a national suicide prevention lifeline and hotline, along with support groups[6], to help. 

Causes

All mental health disorders are triggered by a variety of factors, from traumatic triggers to genetics to chronic stress. These are some of the risk factors[7] that contribute to the development of agitated depression:

Emotionally unavailable or immature parents

  • Little to no emotional support as a child (validation, understanding, or empathy)

Poor coping skills

  • Not taught as a child how to express emotions healthily or manage difficult situations

Chronic stress 

  • Financial worries
  • Dysfunctional family or relationship
  • Difficult living or working situations

Traumatic life events

  • Separation/divorce
  • Loss (death of a loved one, losing your home)
  • Career changes (job loss, pay decrease, retirement)
  • Abuse (physical or emotional)
  • War
  • Trauma, as with accidents or injuries

Chronic health issues

  • Mental illness (anxiety, ADHD, bipolar disorder, or borderline personality disorder)
  • Physical illness or disease (hormonal imbalances, hypothyroidism, diabetes, cancer, heart conditions, etc. While menopause isn’t a chronic health “issue,” per se, it does introduce profound changes, hormonally, that can trigger depression.) 

Genetics

  • Family history of bipolar disorder

Substance use

  • Alcohol and other drugs can amplify or trigger anxiety or depression symptoms.

Agitated Depression Treatment

This type of mixed depression is often diagnosed by a psychiatrist after a physical check-up and talk therapy sessions. They review the symptoms specifically related to mixed mania and note if it coincides with a major depressive episode. 

Often, MDD is the first diagnosis. With time, the specific type of depression, and ruling out bipolar disorder, may be diagnosed. The doctor may prescribe medication along with talk therapy sessions.

Therapy

agitated depression

Many different types of therapy work as an effective treatment plan. It’s important to not get discouraged when a session or two doesn’t go well with a new therapist; it takes time to find the right fit. As soon as you find someone you feel comfortable with, real progress can begin to take place. 

Cognitive behavioral therapy[8] (CBT) and dialectical behavior therapy[9] (DBT) work particularly well for agitated depression. DBT is a modified type of CBT focused on mindfulness, stress, and communication techniques, along with emotional regulation. Group, individual, and online therapy can all be effective methods of treatment. 

Medication

agitated depression

The most common medications[10] for agitated depression are antidepressants, antipsychotics, mood stabilizers, and anti-anxiety (anxiolytic) medications. However, since anxiety can worsen with certain medications and agitated depression displays many anxious symptoms, trial and error over time may be needed to find the right dose. Also, the medicine stays the same, but people change: what might be the right medication now may not be in 6 months, and vice-versa.

How To Cope With Agitated Depression?

Focusing on coping mechanisms related to anxiety, anger, and depression can all help alleviate symptoms. Experimenting with different techniques to find what works best for you, and at what moment, will help you develop the lifelong tools needed to manage life’s difficult moments. 

Learning to manage and alleviate triggers makes managing and alleviating the symptoms possible, and all the more likely to work efficiently when combined with regular therapy. Here are some tips and practices you can begin to incorporate into your day to reach a routine that gives you a sense of safety and calm. 

Try Different Stress Management Techniques

Art therapy agitated depression

With today’s work-focused and overly busy lifestyles, much of the world is living with chronic stress. While these techniques may sound simple, they’ve all been proven to lower stress in short amounts of time. Taking 20 minutes a day, even if at separate moments, to practice just one of these tips will have long-lasting benefits and alleviate symptoms.

  • Journaling[11] or free writing (including writing angrily and letting it all out)
  • Time in nature[12] or green space (walking or sitting)
  • Writing compassionate[13] letters to yourself 
  • Art therapy[14] (creative outlets, time for play)
  • Meditation[15] (start with two- to five-minute guided meditations)

Learn How To Express and Communicate Your Emotions

agitated depression

The world is just awakening to the much-needed practices of emotional communication. Previous generations, and many now, were not raised with parents who were emotionally available. They too likely grew up with overly strict and emotionally unavailable parents and passed on their insecurities, fears, and traumas to their children. 

Without a parent providing loving attention, understanding, empathy, and validation, many people grow up with difficulty expressing their emotions[16]. This leads to anger, anxiety, and depression. Whether it be through books, classes, or therapy, investing your time in developing communication and expression skills is one of the most necessary factors for improving mental health. 

Practice Mindfulness

agitated depression

Adding more mindfulness[17] to your day doesn’t have to take a lot of effort. While it may sound boring or challenging (or make you roll your eyes), starting with a few minutes of paying attention–on purpose, without judgment, every day–will naturally grow with time. It helps you slow your breathing and heart rate, beat yourself up less and reduce negative self-talk, and notice some of life’s little joys (like the slow enjoyment of the intense flavor of a fabulous piece of dark chocolate).  

Create A Routine

agitated depression

The evidence[18] of the importance of a morning and evening routine for mental health is booming. Routines let us know that there is something secure in our day, and that sense of safety and comfort in knowing the future helps to ease anxiety.

Find whatever balance works for you and try to sleep, eat, and work at regular times (and don’t forget to include some time for your daily stress-relieving activities). Having a routine sleep schedule[19] also helps in many other ways.

Add More Nutrient-Dense Foods

agitated depression

There’s no doubt that what you eat affects your mood, both short and long-term. Prioritizing nutrient-dense foods to give your body all the energy it needs to work at its best will go a long way to improving mental health conditions. Keep in mind that 25% of all energy derived from the diet goes to running the brain.

You don’t have to eat perfectly all day every day; aiming for healthy foods around 80% of the time offers huge benefits. To start, you can try adding something green to every dinner or have yogurt with berries instead of ice cream for dessert. One small and manageable habit change at a time is all you need. 

It’s also important to get blood work done to see if you have any deficiencies or hormonal imbalances. Certain deficiencies[20] and health conditions[21] worsen anxiety and depression, and medication might be needed. Otherwise, nutritious foods and vitamins help, such as vitamin B12, folate, vitamin D, and iron for women. 

Move Your Body (In A Way That Feels Good)

agitated depression

There’s no need to stress about going to the gym five days a week. Moving your body in any way (and regularly throughout the day) improves mental health. It could be dance therapy, hiking in nature, or even a daily walk in the park. A total of 150 minutes[22] per week is all you need to see the benefits.

Decrease Alcohol, Drugs, and Caffeine

agitated depression

These substances all exacerbate symptoms[23] of both anxiety and depression and should be avoided. (Alcohol is a depressant, caffeine is a stimulant, and drugs–depending on the type, may be either. There are also several apps to help you track and manage your habits, without the pressure to quit cold turkey. 

The Bottom Line

Agitated depression is a common mental health disorder that includes symptoms of both anxiety and depression. Fortunately, there are many coping techniques you can learn to do on your own to help. In the long run, reaching out for help offers the best chance for treating agitated depression effectively. Although 70%[24] of those with clinical depression can recover with treatment, it’s sobering to remember that the most common cause of suicide is untreated or inadequately treated depression. 

So, don’t be afraid to seek help, even if it’s with a friend (or asking a friend for financial support to afford help). More than half[25] of adults with a mental illness don’t get treatment. With over 50 million Americans experiencing a mental illness, you can improve the odds in your favor by contacting a professional to avoid further suffering.


+ 25 sources

Health Canal avoids using tertiary references. We have strict sourcing guidelines and rely on peer-reviewed studies, academic researches from medical associations and institutions. To ensure the accuracy of articles in Health Canal, you can read more about the editorial process here

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Jennifer Olejarz

Medically reviewed by:

Michael DiLeo

Jennifer Olejarz is a Certified Nutritionist and Health Counselor specializing in binge and emotional eating, stress management, and mental health. She has almost a decade's worth of experience in the health and wellness field writing health articles, guides, and books, along with creating health and nutrition courses. She works one-to-one with private clients to build healthier lifestyle habits and end the lifelong battle of food guilt and diet frustrations. She has degrees in both Psychology and Nutrition from Western University, Canada.

Medically reviewed by:

Michael DiLeo

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