- Agitated depression is not a distinct diagnosis from major depressive disorder.
- An agitated depression can look different from the stereotype of low energy often depicted in film and TV.
- Hyperactive behavior or angry outbursts may be seen with agitated depression.
Depression is one of the most common mental health disorders experienced by adults, yet the symptoms experienced by its sufferers may vary significantly. It's common to associate depression with the stereotypical presentation of it in film and on TV, so it's important to note some of the other forms depression can take.
To begin, take a moment and think about how you define depression. Specifically, visualize someone you imagine is depressed. Ask yourself how they may move or walk, what some of their daily routines may look like, and whether you imagine them being active and functional socially. Do you imagine, for example, that a depressed person is quiet and negativistic, cries often, and spends a lot of time sleeping, even in the middle of the day?
It's a myth that depression is always a passive and withdrawn or depleted experience for the sufferer. Many individuals who suffer from depression have depression which is an agitated version of the disorder. While traditional depression symptoms can be present, many of the typical symptoms of depression exist along with an agitated state.
Is Agitated Depression a Different Diagnosis?
The diagnosis for someone with agitated depression still falls under the general diagnosis of major depressive disorder, as defined in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5; American Psychiatric Association, 2013). It's important to note that of the eight possible criteria included, only five must be met to meet the diagnosis, and those criteria must be met for a period of two weeks or longer. Though one of the eight criteria is a depressed mood, that particular criterion is not required to have a depression diagnosis.
What Does Agitated Depression Look Like in Everyday Life?
- Mood: In a mood disorder, by definition, the mood of the sufferer interferes with positive and consistent daily functioning at home, at work, and in close relationships. With agitated depression, the mood may be irritable or change from moment to moment.
- Movement and energy: The individual's energy and movement may be off, taking the form of higher energy and increased movement. The individual may be restless, may pace, or be overly active, or they may be overly talkative and present a flight of thoughts or ideas.
- Aggressive behavior or outbursts: The individual may also be more verbally or physically aggressive than usual, and may display impulsive behavior or angry outbursts. It may seem to others as if the individual is looking to start a conflict or flight, and can't seem to self-soothe in a healthy, normal way.
Agitated Depression in Children
As a psychologist, I can share anecdotally that many mental health professionals and physicians who treat children note that kids who are depressed often appear to have more irritable mood and active or inconsistent behavior, as opposed to having the traditional symptoms of sadness, withdrawal, and isolation.
Overall, recent research has found that approximately 2.4 million children, or 4 percent, had been diagnosed with depression (Lebrun-Harris, Ghandour, Kogan, and Warren, 2022). It’s crucial to note that this statistic only includes the children who were diagnosed, meaning that many other children may be suffering but haven't yet been diagnosed.
It’s also important to note that, because depression may appear as agitation in some children, a child’s true depressive symptoms may be misperceived. Their possible depression may not be assessed as a result.
How to Treat Agitated Depression
Any depression that reaches the level of significant impairment in daily functioning for two weeks or longer should lead to consultation with a health professional, and that professional can direct one to appropriate places for treatment.
Among the most effective treatments for depression is cognitive behavior therapy (CBT), a type of therapy for which the vast majority of licensed mental health professionals have received training. Research shows that CBT is not only efficacious in the acute treatment of depression, but that it also appears to have an enduring effect that protects against subsequent relapse and recurrence of the depression (Driessen and Hollon, 2011).
In order to know whether a mental health provider is able to provide this type of treatment, it’s important to ask specific questions. Consider asking any of the following questions: Is CBT something you practice often to treat patients? Can you give me examples of how you will use the session time? How many sessions do you typically need to treat depression?
Education is a crucial component of seeking out and receiving mental health treatment. In addition, active engagement in the work of treatment in between sessions can bring greater improvement in depression symptoms. CBT will typically draw on assignments and tasks to work on in between sessions, and these are highly recommended to lead to successful results.
Anyone suffering from severe depression or having suicidal thoughts can get immediate support from the National Suicide Lifeline by texting or calling 988. To find therapy near you, visit the Psychology Today Therapy Directory.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Driessen E, Hollon SD. Cognitive behavior therapy for mood disorders: efficacy, moderators and mediators. Psychiatric Clinics of North America. 2010; Sept;33(3):537-55.
Lebrun-Harris LA, Ghandour RM, Kogan MD, Warren MD. Five-Year Trends in US Children’s Health and Well-being, 2016-2020. JAMA Pediatrics. 2022;176(7):e220056.