The term agitated depression denotes a mental condition of unhappiness, low mood and inability to get pleasure from anything which is thought to be pleasing for a normal person. If this condition is persistent for some weeks is called depression. It interferes with a patient’s daily activities. Among the features of depression most common are, disturbance of sleep, altered eating behavior (either patient eat too much or too little) poor concentration and decision making and thoughts of dying along with suicidal tendency.
Among many types of depression agitated depression is one entity. Agitated depression as against typical features of depression (a drained person with little interest in surrounding and little talk) is characterized by irritable mood, aggression and short-temper. For a patient of agitated depression, it becomes difficult to overcome his anger and aggression and it becomes a problem for the care takers.
Patients with agitated depression often have in their mind that other people misunderstand them and don’t know and care about their feelings. The most prevalent age of agitated depression is middle age or old age; young peoples are not exempt of this condition as agitated depression has been diagnosed in young people too.
Who Should Be Suspected As Having Agitated Depression
This kind of depression should be suspected in a person if he or she has profound agitation, aggression and difficult to manage anger. These are typical symptoms of agitated depression. Patient may have some additional symptoms too these are,
- Person with often becomes ‘antsy’ it means he or she feels difficult to sit or stay at one place for even a little long time. They walk and move anxiously instead of sitting at a place.
- Person with has sudden and spontaneous mood swings. He or she will be sitting cool and calm talking in a sensible and composed manner in one moment, the very next moment suddenly becomes agitated with physical and emotional outburst. Verbal outbursts may be present.
- Winging of hands may be present in a person with agitated depression.
- Person has intense thoughts and feelings
- Frequently violent verbal outbursts occur in such a person, showing aggression, even abuses.
- Person talks with high speech pressure, he or she speak continuously
- Person has endless thoughts which are without any solid background
- Person with agitated depression pulls his or her clothes or tear them.
- Person is so aggressive and agitated that he may harm others.
- Person may have strong suicidal tendency or thoughts about it, which is quite dangerous
- Person is anxious and restless
- Person suffering from this condition find it hard to define his or her problems
If all or some of these symptoms are present in a person, he or should be suspected having agitated depression and a psychiatrist should be consulted.
How Agitated Depression Is Diagnosed
Diagnosis of agitated depression should be done by a psychiatrist after careful and thorough evaluation. In many cases depression may be as a result of some medical ailment.
The Diagnostic criteria used for agitated depression or mixed state is Statistical Manual of Mental Disorders(DSM-IV), according this criteria a patient is said to have agitated depression if he or she meets the criteria for a major depressive episode and a manic episode nearly daily for at least one week . In other words, agitated depression is diagnosed if the person has
- a major depressive episode and
- two of the following
- Motor agitation( patient feels he has to move continuously)
- Psychic agitation ( patient has constant tension inside)
- Racing thoughts.
Again the diagnosis of agitated depression should be done by an experienced psychiatrist.
Forms Of Agitated Depression
Agitated depression has three major forms
Psychotic Agitated Depression: this form of agitated depression is a severe form of melancholia
Non-psychotic Agitated Depression: this form is a moderate one with some agitation
Excited Agitated Depression: this form of agitated depression is accompanied by racing thoughts
Treatment Of Agitated Depression
Treatment of agitated depression is combination of Psychotherapy and Medicines, but it should be remembered that patients with agitated depression have a behavioral problem so their compliance with treatment remains poor. As a general advice, an experienced psychiatrist should diagnose this condition correctly then make a longtime association with the patient in order to get the desired results of treatment..
Psycotherapy
Psychotherapy sessions are done with the patient to help him learn anger management and also patient is taught about relaxing techniques. If psychotherapy is done properly it yields good result along with medicines.
Pharmacotherapy
Following medicines are useful in treatment of agitated depression
- Mood stabilizers: mood stabilizing medication are useful in managing the sudden mood swings, these include anticonvulsants like valproic acid and lamotrigine
- Atypical antipsychotic also have good treatment results in agitated depression, commonly used atypical antipsychotics include olanzapine, ziprasidone and aripirizole. First generation antipsychotics like haloperidol are also used some times. Use of lithium is controversial.
Mood stabilizers improve the manic symptoms but they are not much efficacious in improving depressive symptoms.
Complications Of Agitated Depression
If untreated it evolve into bipolar disorder and results in dysfunction at work and family relations occurs and chances of suicide even homicide increase.
Prognosis Of Agitated Depression
No special measures are known to prevent it becoming bipolar disorder. If patients follow healthy life style with sleep and regular exercise it helps in improving the condition. Some drugs are known to trigger the symptoms of agitated depression for example cocaine and amphetamine, they should be avoided. Relapses can be prevented or their severity can be reduced if patient strictly adheres to treatment for agitated depression.