Depression tends to bring hopelessness, sadness, or helplessness. However, some people also experience agitation, including symptoms of anxiety and restlessness.

Agitated depression is not a medical term, but some people use it to describe this combination of anxiety and depression.

Mixed depression, or major depressive disorder with mixed features, is another way to describe depression that also involves agitation and physical restlessness.

A study from 2004 found that out of 434 people with major depressive disorder or bipolar disorder (which can also involve depression), 34.7% had symptoms of agitation.

Agitation can occur with major depression, bipolar disorder, and schizophrenia.

In this article, learn more about agitation, how it affects a person, and what to do if it occurs.

The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) lists criteria to help a doctor diagnose various mental health conditions.

Depression

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Depression with agitation is known as a 'mixed episode' of depression.

For a diagnosis of depression, a person needs to have experienced low mood or loss of interest or pleasure in life for at least 2 weeks.

Also, they will have experienced at least five of the following symptoms:

  • feelings of sadness, hopelessness, or irritability nearly every day
  • a lack of interest or pleasure in activities almost every day
  • significant weight loss, or a change of appetite that results in weight loss or gain of 5% of body weight within a month
  • sleeping too much or too little
  • psychomotor agitation
  • restlessness, or feelings of having "slowed down"
  • fatigue, or a lack of energy, nearly every day
  • feelings of worthlessness or excessive and unexplained guilt almost every day
  • difficulty thinking clearly, concentrating, or making routine decisions
  • thoughts of death, self-harm, or suicide

Agitation can be one sign of depression. What others might occur? Learn more here.

Agitation

Symptoms of agitation include:

  • angry outbursts
  • disruptive or impulsive behavior
  • excessive talking or movement
  • difficulty sitting still
  • problems with focusing or having a conversation
  • pacing or shuffling the feet
  • tension, anxiety, and irritability
  • wringing the hands or clenching the fists

Symptoms can appear suddenly or over time. They can also range from a nagging sense of unease to aggression.

If agitation leads to impulsive or aggressive behavior, it could result in harm to the person or to others.

Frequent agitation can affect a person's:

  • relationships
  • work or school performance
  • overall health and safety

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Possible causes of agitation may be a new environment, or substance withdrawal.

Agitation is not a condition, but it may be a symptom of depression or another mental health condition, such as bipolar disorder or schizophrenia.

Causes of depression may include biological, genetic, environmental, and psychological factors.

Aside from depression and other mental health conditions, other causes of agitation may include:

  • being in a new environment
  • substance use or withdrawal
  • having alcohol in the system

Some medical conditions also increase the risk of agitation, such as:

  • infections, including sepsis
  • dementia
  • endocrine problems
  • exposure to toxins
  • electrolyte imbalance

People with some of these conditions, such as dementia and substance use, may also have depression and anxiety.

Very often, the individual, their doctor, and the people around them do not know exactly why agitation develops.

Agitation often occurs alongside depression, but it can also be a feature of bipolar disorder, schizophrenia, dementia, and other conditions — some of which can also involve depression.

Agitation can also occur with substance abuse disorder, personality disorder, autism, and other conditions.

A 2018 study looked at data for 583 people with schizophrenia or bipolar disorder who also experienced agitation.

Of these people, over half reported feeling:

  • uneasy
  • restless
  • nervous
  • tense
  • unable to sit still

People also reported feeling:

  • irritable
  • short tempered
  • fidgety
  • wound up
  • over excited

In fewer than 20% of cases, people said they had felt:

  • hostile
  • uncooperative
  • lacking in control

Less commonly, they reported feeling aggressive or violent.

Symptoms ranged from mild to severe. Around half of the participants said they had visited a hospital in the previous year due to agitation.

In total, 71% were aware when they were becoming agitated, and 61% knew what their triggers were. Most said that they knew what to do to control their agitation, but around 16% felt that there was nothing they could do.

Bipolar disorder

Bipolar disorder has many features, but one of the key symptoms is mood changes. Agitation, or agitated depression, may have links with this condition.

Bipolar disorder can involve fluctuations between a low and high mood, but mixed states are also possible. Some people experience hypomania, a high mood that is less extreme than mania.

Agitation is a common feature of hypomania.

Schizophrenia

Schizophrenia involves disorganized thinking, agitated movements, delusions, and in some cases, hallucinations.

Agitation can also be a feature of schizophrenia. It is often related to symptoms of the condition, such as disturbing auditory hallucinations.

Learn more about the symptoms of schizophrenia here.

If agitation is making daily life difficult, or if a person is at risk of harming themselves or someone else, they should see a doctor.

A loved one may need to help them understand how this will help.

A doctor will ask a person to describe the symptoms they are experiencing, asking questions such as:

  • When did the symptoms begin?
  • What makes them better or worse?
  • Have you changed your intake of alcohol or other substances?

Sometimes, a loved one can help by describing the changes or behaviors they have observed in the other person.

Criteria from the DSM-5 can help a doctor diagnose depression or another mental health condition, but they do not address agitation or agitated depression.

A variety of approaches can help a person with agitated depression. We discuss these in more detail in the sections below:

Sedative medications

Medications may help calm a person quickly.

Examples include:

  • midazolam (Versed), a benzodiazepine
  • olanzapine (Zyprexa), an antipsychotic drug

These medications work quickly to help a person feel more calm. They can provide temporary relief.

Antidepressant medication

Doctors may prescribe a variety of drugs to relieve depression, including antidepressants.

If these medications do not help, a doctor may change the drug or add another one. They may prescribe an anti-anxiety medication or a mood stabilizer, depending on the diagnosis.

Antidepressants can take 2–4 weeks to start working. A person may need to continue taking them for 6–12 months.

Counseling

A qualified and experienced counselor can help a person identify thoughts and feelings that can signal the start of agitation or depressive symptoms.

Therapy can help a person focus on thoughts and behaviors that can help them feel better when they experience agitated depression.

Self-help tips

The following tips can help some people when they start to experience agitation:

  • Get some space. For example, go outside for a walk.
  • Talk to a trusted person about any increasing feelings of agitation, as they may be able to help deescalate the situation.
  • Notice thirst, hunger, or any other feelings of discomfort.

Stress relieving techniques

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Physical activity may help relieve stress.

Tips for relieving stress, anxiety, and depression include:

  • getting enough physical activity
  • following a healthful diet
  • practicing good sleep habits
  • meditating
  • deep breathing
  • spending time doing enjoyable activities with friends
  • gardening or spending time in the open air
  • journaling

There is no one single way to relieve agitated depression, as each person's situation will be different. A doctor will likely recommend a variety of approaches, including medication and counseling.

Sometimes, it can take time to find the right combination of medications, therapy, and stress relieving techniques that will help.

A person should persevere with their treatment plan as much as possible, and they should speak to a doctor if they feel that, after giving it a good try, is it not working.

Agitation can occur alongside depression and various other mental health conditions. There is no cure, but suitable treatment can help improve a person's quality of life.

Anyone who experiences thoughts of suicide or is at risk of harming themselves or others should receive emergency medical attention.

A medical professional can help identify ways to help a person feel calm and reduce the risk of harm.

Q:

My best friend has bipolar disorder and often experiences agitation. They stopped taking medication, as they felt it did not suit them. Sometimes, it makes me feel angry or afraid when the tension starts rising. What can I do to help both of us?

A:

This can be a serious challenge, and although there is no “one-size-fits-all” approach, communication is key. First, wait until your friend is not agitated and their symptoms are stable. During these times, discuss your concerns with them and describe how you feel when they stop taking their medications and their symptoms of agitation start to return.

Being honest with your friend is important. Remind them that if they do not like the way medications make them feel, they should discuss this with their prescriber. Discuss how you have noticed their behavioral changes when they stop taking medication.

If, after all else, you continue to feel afraid, you need to take care of yourself and be certain that you are not in harm’s way. This may include limiting your contact with your friend during these times, or if things get worse, dissolving the friendship entirely in order to stay safe.

Timothy J. Legg, PhD, CRNP Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.