If you've ever had a depressive episode where you've lashed out at someone you loved, you know the miserable feeling that comes after you realize how you've hurt someone.
People dealing with a depressive disorder know they don't feel like themselves when in a depressed mood, but typical depression symptoms mean that sometimes, you say something cruel or hurtful when in the throes of a severe depression episode.
If you find yourself doing this in a pattern — for example, if you lash out often — you may have a depressive disorder called agitated depression.
Agitated depression is a relatively new type of depression, and it's not formally recognized, but for people with depression who feel agitated all the time, it may be the best way to describe what they suffer from — and the necessary description to get the help they need.
Read on to learn more about agitated depression and what to do about it.
Agitated depression is a bit complicated to explain, so stick with us. To understand it, you first need to understand depression.
The National Institute of Mental Health (NIMH), defines depression as a mood disorder — one characterized by a pattern of feelings that can be described as sad, low, empty or hopeless.
Mood disorders like depression are staked on the concept of a pattern — for example, if you cried last week over something sad, you are not depressed, but if you’ve been crying or feeling numb for several weeks, that may be an indicator of depression.
What separates mood disorders from just a mood is the recurring pattern of the feeling, and whether or not it is affecting your ability to think and perform in a normal way on a regular basis.
Depression is likewise not a one-size-fits-all disorder. In fact, there are many versions of depression, including seasonal affective disorder (aptly named SAD) and severe or major depression.
There’s another type of mood disorder you may have heard of, which was commonly referred to as “manic depression” or “manic depressive illness.” We now call it bipolar disorder.
Bipolar disorder can still be described as manic depression, as it’s characterized by unusual mood shifts that a person experiences. One moment they might feel completely incapable of getting out of bed, and the next they may be full of energy and hyper focused.
These highly energized episodes are referred to as manic episodes, and they’re often the opposite extreme from depressive episodes. There are several forms of bipolar disorder, and they include differences in severity and length of symptoms.
One of the key traits of bipolar disorder is that, in some cases, an individual with bipolar may experience irritable phases of their moods, during which they can be easily agitated when at high-energy levels. That risk of becoming agitated today is sometimes referred to as agitated depression.
It’s helpful to understand that agitated depression is a gray area as far as the mental health community is concerned. It’s widely discussed, but it hasn’t received the formal classifications that some other forms of depression have. Its “diagnostic validity” has been doubted in official capacities, and though some data supports it as a subtype of depression, those conversations are ongoing.
Some studies have found that, even if it’s not officially recognized, agitated depression has utility in the field for helping mental health professionals diagnose symptoms more clearly, as they can more effectively tailor treatments — especially in cases where antidepressants could worsen the agitation.
Given that agitated depression isn’t formally recognized as a subtype of depression, it’s easy to understand that there are unanswered questions, and one of those is what triggers agitated depression.
There also isn’t firm information on what causes related conditions like bipolar disorder. Evidence suggests a mixed bag of possible causes for bipolar disorder, for example, including genetics, one’s environment and brain structure among many other things.
Most experts agree there’s likely no one cause of bipolar or any form of depression for that matter, and instead your risk of the condition is determined by an accumulated value of factors that paint a full picture.
There are many overlapping symptoms between bipolar disorder, depression and agitated depression due to their relationship with one another.
We’ve already covered some of these above, but in summary, agitated depression will typically show many of the symptoms of depression — which include fatigue, sleep loss, motivation problems, reckless behavior and occasional substance abuse.
One 2012 study looked at the relationship between agitated depression and substance abuse and actually found an elevated likelihood of substance abuse in individuals with agitated depression vs. other depression forms. The study however did not conclude whether agitated depression made someone more likely to abuse substances, or whether substance abuse might impact someone’s depression symptoms and subtypes.
The most obvious depressive disorder symptom (in the study) shared by agitated depression was the increase in irritability and anger.
It’s stating the obvious, but the key agitated depression symptoms involve forms of irritability, along with other depressive issues.
Treating depression is already a complex process, and while there are effective treatments out there, it becomes more difficult to find the right treatment plan or combination of treatments when you involve bipolar disorder or agitated depression.
Some research suggests that treatments like antidepressants alone might cause spikes in agitation, meaning that what’s good for addressing some types of depression might be dangerous for other types.
Treatment option suggestions should come from a mental health professional, who can more effectively and accurately assess you and your needs once they’ve had the chance to discuss your concerns.
Once you’ve consulted with a healthcare professional and they have a better idea of what you’re experiencing, they may prescribe antidepressant medications like selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants — mood stabilizers to help control serotonin levels and reduce the effects of your depression.
It’s important for SSRIs to be prescribed under supervision, as the FDA has issued a blackbox warning for the medications based on evidence of increased risk of suicidality in some age groups.
Another option you may explore with a mental healthcare provider is therapy. Forms like Cognitive Behavioral Therapy (CBT) may help you learn to regulate and understand your mood shifts and the thoughts that can cause them, ultimately helping you to feel more in control of your brain.
Easy at-home options like meditation and breathing exercises have shown effectiveness in the treatment of mood disorders like depression.
A depressive episode characterized by agitation is something to be concerned about, particularly if you find yourself lashing out at those you love.
Family and friends can be patient and supportive even when your depressive symptoms cause them pain, but that's not an excuse to avoid getting the help you need.
The good news is that you don't have to do it alone.
If you're experiencing anything that mirrors clinical depression, bipolar disorder, or symptoms of agitated depression, it's time to do something about your mental health. The next step is to contact a mental health professional. It’ll help you save your relationships — and yourself. And everyone deserves that, including you.
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Kristin Hall is a board-certified Family Nurse Practitioner with decades of experience in clinical practice and leadership.
She has an extensive background in Family Medicine as both a front-line healthcare provider and clinical leader through her work as a primary care provider, retail health clinician and as Principal Investigator with the NIH.
Certified through the American Nurses Credentialing Center, she brings her expertise in Family Medicine into your home by helping people improve their health and actively participate in their own healthcare.
Kristin is a St. Louis native and earned her master’s degree in Nursing from St. Louis University, and is also a member of the American Academy of Nurse Practitioners. You can find Kristin on LinkedIn for more information.