Agitated Depression

Agitated depression: A major depressive disorder with restlessness and motor excitement. Agitated depression was once called melancholia agitata. It is now also known as mixed mania. 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 occur 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:
o Motor agitation
o Psychic agitation or intense inner tension
o 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
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.

Agitated depression in bipolar I disorder: Research

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.
Agitated Major Depressive Disorder

At least 2 of the following manifestations of psychomotor retardation (not more subjective anxiety) are required for several days during the current episode

1. Pacing
2. Handwringing
3. Unable to sit still
4. Pulling or rubbing on hair, skin, or clothing
5. Outbursts of complaining or shouting
6. Talks on and on, or can’t seem to stop talking


Agitated Depression in Bipolar I Disorder
filed under Bipolar Disorder Symptoms & Diagnosis

A new study suggests that agitated depression afflicts one fifth of those with bipolar I disorder. “Mario Maj and colleagues from the University of Naples studied all patients with bipolar I disorder presenting to the psychiatric department who fulfilled Research Diagnostic Criteria for agitated depression. These 61 patients were compared with 61 bipolar I patients with non-agitated depression, and 61 bipolar I patients with an index episode of mania” (

Every 2 months the participants were tested on the Comprehensive Psychopathological Rating Scale (CPRS) and the Schedule for Affective Disorders and Schizophrenia. There were 22 men and 39 women with agitated depression. The average age of the group was 41.6 years. Those with agitated depression tended to be older when they first used any psychiatric services and had more psychiatric admissions before their “index episode” of mania.

There were several negative symptoms that seemed to accompany those with agitated depression, such as agitation, irritability, overly sexual, etc. Delusional guilt was experienced by 15 of them, and no one in the agitated depression group had delusions of grandeur or an “elated” mood.

Those with agitated depression scored higher on their CPRS and took longer to recover (12 weeks as opposed to 9 weeks). The researchers involved in this study believe that the effects of mood stabilizers on this group of patients should be studied, as they might have differing effects.

Original Source: Agitated depression common in bipolar I disorder. PsychiatryMatters.MD.

This research study was originally published in Am J Psychiatry 2003; 160: 2134-2140.
Posted by at September 7, 2005 12:57 PM

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