What Is Agitated Depression?

Medically reviewed by Paige Henry, LMSW, J.D.
Updated May 14, 2024by BetterHelp Editorial Team
Please be advised, the below article might mention trauma-related topics that include suicide, substance use, or abuse which could be triggering to the reader.
Support is available 24/7. Please also see our Get Help Now page for more immediate resources.
When we think about depression, we typically envision someone who feels too sad to engage with several everyday aspects of life. For many people who are living with chronic depression, this is true. Often, people who experience depression feel so down that they may have trouble leaving their beds or doing daily tasks like making meals or getting work done. By contrast, people who live with high levels of anxiety often feel — and present — as though they are full of nervous energy. It may surprise you to know that these symptoms can also be present in people who are living with depression, often known as agitated depression. 

When people with depression experience extreme levels of agitation and irritability, it’s possible that they may be experiencing a unique subset of depression known as “agitated depression.” In this article, we’ll take a closer look at agitated depression to learn more about what this mental health condition is and explore the treatments available.

iStock/fizkes
Feeling both sad and anxious could indicate agitated depression

What is agitated depression?

Agitated depression is a specific form of depression in which a patient exhibits the following symptoms: irritability, fidgeting, physical restlessness, handwringing, outbursts, or picking at their skin. The intensity of the agitation fluctuates, with instances where the symptoms of anger are more pronounced and persistent. Generally, people who have major depressive disorder are thought to have lower energy levels and are seen to be less active, but this is not the case with agitated depression. People with agitated depression can show symptoms of lethargy, but it is far less common. Instead, they are often fidgety and more active than people with other depression types. This type of depressive disorder is not listed by name with other mental disorders in the diagnostic and statistical manual of Mental Disorders (DSM-5), but is instead considered a valid depression subtype with mixed features. 

Treating agitated depression often requires the help of a professional. The most common treatment option is a combination of medication and therapy. Medications used to treat agitated depression include antidepressants, anti-anxiety medications, and mood stabilizers. Please consult with a health care provider or primary care physician before considering any medication options.

Available treatments

Managing agitated depression can be challenging but is entirely possible, given you are willing to put in the time and often symptoms of depression can be reduced with therapeutic intervention. There are many approaches to treating depression. The type of treatment that works most effectively for you will depend on your specific experiences and needs, including the kind of plan a therapist designs for you. To give you an idea of what you might be able to expect, many helpful treatment plans include a combination of therapy and medication. In some cases, a psychiatrist may recommend electroconvulsive therapy. Medications that are commonly used to treat mixed-state or agitated depression may include antidepressants, mood stabilizers, and anti-anxiety medications.

Each of these medications can be uniquely helpful in its own way. For example, antidepressants can help to alleviate depression symptoms, while mood stabilizers can help people avoid severe mood swings and angry outbursts associated with agitated depression. Likewise, specially formulated medications to reduce anxiety may help you feel a general sense of calm and holistically reduce your symptoms. However, it’s important to remember that you should only take medication that has been prescribed to you by a physician, whether that’s your primary care doctor or a licensed mental health professional.

Your doctor can also prescribe additional treatments beyond— or instead of — medication. For example, some people benefit from regular sessions with a therapist in addition to an antidepressant, mood stabilizer, or anti-anxiety medication when treating depression. Others don’t respond well to medication at all and find significant relief from their symptoms after solely treating their agitated depression with therapy. Connecting with a therapist can be highly beneficial because therapy provides you with professional insight into understanding agitation symptoms and an arsenal of tools to help you navigate depression.

You may feel overwhelmed and isolated if you’re experiencing mental health challenges. Working with a therapist can remind you that you’re not alone. The work you do in therapy may sometimes be uncomfortable because it may have you work through events or memories that have led to a depression state. Yet, it’s important to remember that the exercises your therapist prescribes have been designed with your healing in mind and their goal is to help you. As a result of this work, you may ultimately experience relief from your symptoms and enjoy the healthy life you deserve.

Finding the right treatment is especially important for people who are experiencing agitated depression because it may cause a variety of unpleasant symptoms that can put you at a higher risk of self-harm and suicidal thoughts. If you’re experiencing any of these feelings as a result of your agitated depression, it’s important to seek help. 

If you or a loved one is experiencing suicidal thoughts, please contact the 988 Suicide and Crisis Lifeline at 988. Formerly called National Suicide Prevention Lifeline the 988 Suicide and Crisis Lifeline has counselors and suicide prevention staff available 24/7 in both English and Spanish, and there is help available via live chat on the lifeline’s website.

How agitated depression affects your life

Agitated depression (also known as "melancholia agitate") is a specific type of depression with symptoms related to restlessness and sometimes anger. While this type of depression can stand alone, it is often accompanied by other mental health disorders.

Symptoms of agitated depression

Agitated depression has specific symptoms, the most common being extreme irritability. Sometimes people with this type of depression will explode into angry outbursts for no apparent reason. They may become offended or annoyed by something that would normally be considered insignificant. This can be difficult for families of people who have this type of depression, who may feel they are walking on eggshells when their loved one is in this type of irritable state.

Other common symptoms include fidgeting, psychomotor agitation, pacing, and general restlessness. If you notice someone is having trouble staying still, it is possible they could have a form of agitated depression. Even nail-biting, handwringing, and other fidgety behaviors can be symptoms of agitation. You may notice significant weight loss as a side effect of this type of depressive episode. 

Another symptom is racing thoughts. Racing thoughts can make a person ramble on and on about seemingly nothing. People who have agitated depression can have difficulties settling down, and they might struggle to maintain a sense of calm as easily as others. This can lead to their minds running too fast, perpetuating their feelings of restlessness.

What causes agitated depression?

Some types of stress or trauma typically cause agitated depression. This could be due to the loss of a loved one or some other major life event. Something such as losing a job has the potential to cause agitated depression in certain people.

If you are experiencing trauma, support is available. Please see our Get Help Now page for more resources.

Agitated depression can be associated with several other mental health conditions and medical problems, including bipolar disorder, depression, anxiety or even hypothyroidism. Hormonal imbalances have been known to cause agitated depression, and may need to be addressed to alleviate the symptoms. There are also cases where certain medications, specifically depression medications, that may not properly treat agitated depression. 

Agitated depression diagnoses

A psychiatrist can perform the diagnosis of agitated depression. They will need to examine the person by picking up on certain symptoms of depression exhibited. Thus, a diagnosis is made by observing a person's behaviors that may align with depression, talking to the person, and reviewing the person's medical history. To diagnose someone with agitated depression, they often will have a history of experiencing a major depressive episode and have agitation symptoms such as racing thoughts, restlessness, and fidgeting. A psychiatrist will also note any angry outbursts that have been reported in these states of depression.

Coping with agitated depression

It’s also helpful to know that, in addition to therapy and medication, you can do many other things to decrease your agitated depression symptoms and improve your quality of life when living with depression.

iStock/stefanamer

Exercise

Exercise releases endorphins, which are natural antidepressants. Exercise is beneficial for most anyone, but it can be especially helpful for people who are struggling with their mental health or have depression. If you can get up, get your body moving, and encourage the production of your body’s natural “happy chemicals,” you may be surprised to find yourself feeling better. This can be difficult to find motivation to do when living with depression, so finding a buddy to hold you accountable to attend workout classes with is a great way to get started. On other days where you may have severe depression symptoms, even going for a walk is a great option.

Avoid caffeine

Caffeine is known to reduce serotonin levels. However, if you’re experiencing symptoms of agitated depression, it’s important to know that caffeine can make you feel anxious, which may not help. If you regularly drink a lot of coffee — or even caffeinated tea — you may want to gradually reduce your caffeine intake to see if it alleviates some depression or anxiety symptoms.

Soak up some sun

Sunlight exposure helps boost your vitamin D levels, and that in turn can improve your mood. Sitting in the sun can even help improve your cognitive function, which often becomes impaired with agitated depression.

Sleep regularly

Sleeping can be difficult when you feel anxious or depressed— and it can be even harder if you’re experiencing both at the same time. As a result, it may feel impossible to develop a strict sleeping schedule and stick to it. But it’s still important to do everything you can to cultivate a healthy relationship with sleep. Most people’s mental and physical health improves after a night of high-quality sleep, and this is especially true for those experiencing symptoms of mental health conditions like agitated depression.

So, wherever possible, try to do little things to improve the quality of sleep you’re getting. For example, minimizing the time you spend on your phone before bed, going to sleep at the same time each night, and showering with products with calming scents like lavender can help create a restful environment before bed.

These are just a few natural habits that you can incorporate into your daily life without a great deal of difficulty. However, it’s important to remember that — while all of these things can improve your mental and physical health — they are all mere supplements for treatment. In most cases, these practices shouldn’t be your only strategy for treating your symptoms of agitated depression because they often cannot provide permanent, long-lasting relief for your symptoms. Therapy and medication, in some cases, can provide you with hope and healing to truly improve your mental health.

Living with agitated depression can be exhausting and upsetting. Your symptoms can leave you feeling frustrated and unable to connect with others or enjoy the things that used to bring you pleasure in life. If you feel that your symptoms of agitated depression are holding you back in life, it’s important to remember that you don’t have to battle these symptoms forever, and you certainly don’t have to do it on your own.

Online counseling with BetterHelp

If you’re experiencing agitated depression as a result of a depressive disorder, bipolar disorder, or another mental health condition can be difficult to do on your own. Plus, you shouldn’t have to do it alone. Consider connecting with an online therapist through BetterHelp to get started with a treatment plan that suits your needs. BetterHelp’s licensed therapists are trained in various specialties so that you can find someone with experience in the area you’re struggling with. 

A major depressive episode often makes it difficult to get out of bed, socialize with loved ones, or enjoy the activities you once did. Finding the motivation to make it to therapy sessions with depressive symptoms can feel just as exhausting. Online therapy allows you to participate in sessions through video chats, phone calls, or a live messaging feature. You can still get support even from the comfort and serenity of your bed or home, making it more convenient and easier to get the care you need.

Getty/AnnaStills
Feeling both sad and anxious could indicate agitated depression

Online counseling for agitated depression

Online therapy can be a powerful tool for coping with symptoms of agitated depression and various other mental health conditions. One medically reviewed study found that psychotherapy delivered via the internet was just as, if not more effective, than in-person interventions for the same problems. Researchers found that participants receiving online therapy experienced a reduction in their depressive symptoms and had high rates of satisfaction with the treatment they received. 

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Takeaway

Agitated depression may look different from major depression and other mental health conditions like bipolar disorder and anxiety, but it is often no less challenging. Coping with the condition is possible with the right support and tools, such as guidance from a licensed online therapist. You can manage your symptoms and live a healthy, productive life through changes to your everyday habits and continued pursuit of treatment options for your mental health.
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