Depression is often portrayed as sadness and low energy. In cases of agitated depression, anger and physical restlessness play a role.
Living with depression doesn’t always manifest as feeling “down.” Agitated depression is a term used when someone with depression has feelings of agitation, like anxiety, excess energy, and physical restlessness.
People living with agitated depression often experience dueling emotions. They note feeling hopeless and apathetic, as well as experiencing irritability, physical tension, racing thoughts, and outbursts of anger.
Depression symptoms can look different for each person — and to the family and friends around them.
People experiencing irritability and anxiety in the mix of “typical” depression symptoms are not alone. One 2004 study found that 34.7% of participants with major depressive disorder or bipolar disorder reported symptoms of agitation.
Although dealing with depression and agitation symptoms can be challenging, finding the right treatments can help you manage your symptoms.
Agitated depression isn’t a clinical diagnosis that appears in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).
It’s a term used to describe feeling agitated as a symptom of depression or bipolar disorder.
When you live with agitated depression, you still experience the lows of a depressive episode. You may still feel low energy, have little interest in visiting with family and friends, and have difficulty finding joy in the things that used to delight you.
But these feelings exist alongside an agitated state. Constantly feeling irritated, talking excessively, and pacing are signs of agitation.
According to the DSM-5, major depressive disorder with symptoms of agitation would be called “major depressive disorder with mixed features.” It’s also referred to as “mixed depression” or “mixed features.”
Agitation in conjunction with manic or hypomanic episodes may also be called “mixed features” in a bipolar disorder diagnosis. This replaces the old term “mixed mania.”
Agitated depression can closely resemble episodes of mania or hypomania, common in bipolar disorder. Because of this similarity, the underlying mental health disorder causing agitated symptoms can be difficult to diagnose.
When you think about agitation, you may naturally think about feeling angry. While anger can be a feature of agitation in mental health disorders, it’s only one way agitation is expressed.
Agitation can show up as many symptoms and behaviors, including:
- aggression, impulsive behavior, and angry outbursts
- excessive energy or movement
- inability to sit still or restlessness
- irritation and feeling “on edge”
- physical fidgeting, such as hand-wringing, nail biting, picking at skin, or pulling on clothes and hair
- quick or excessive talking
- racing thoughts
- repetitive movements, such as pacing or rocking
- trouble concentrating on tasks
In mixed depression with symptoms of agitation, agitation coincides with a depressed mood lasting 2 or more weeks. A depressed mood can look like:
- ongoing feelings of hopelessness, sadness, and loneliness
- loss of interest in socializing or activities you used to enjoy
- feeling low energy
- getting too much or too little sleep
- difficulty concentrating
- thoughts of death or suicide
While they wouldn’t be characterized as agitated depression, many other mental health disorders are tied to feeling agitated, including:
- attention-deficit hyperactivity disorder (ADHD)
- personality disorders
- physical illness and exposure to toxins
- psychotic disorders
- schizophrenia spectrum disorders
- substance use disorders
Living with agitated depression doesn’t always mean you’re living with major depressive disorder. Agitation can appear in other types of depression, too.
Major depressive disorder is a diagnosis, while agitated depression is used to describe prominent symptoms in depression or depressive episodes — no matter which diagnosis it appears in. However, agitation is most common in major depressive disorder.
Rather than always fitting into neat categories where people exhibit every listed symptom of a disorder, many in the mental health field believe that mental health exists on a spectrum. Since depression can take on many forms, “mixed features” is more inclusive than the term agitated depression.
Why is it “mixed features” and not “anxious distress?”
Anxious distress is another specifier for major depression in the DSM-5. This specifier is used when symptoms of anxiety – but not necessarily agitation — coincide with depression.
Coping with agitated depression means more than managing the sadness and despair typical of a depressive episode. But there are many helpful approaches you can take at home or with the support of a mental health professional.
Stress can trigger intense emotions, so managing stress is a great way to get ahead of potential agitation. When emotions feel really big, sometimes the best way to cope in the moment can be giving them at least 30 minutes to run their course. Consider trying these stress-busting methods:
- Take a walk. Playing a soothing playlist, a funny podcast, or something else can take your mind off your feelings if you feel like anger is building. Aiming to notice different details on your walk or trying a new route can increase mindfulness.
- Find a hobby you enjoy. Hobbies can bring us joy and build community. Consider a hobby that gets you moving or meeting new people. Feeling fully immersed in what we’re doing — called “flow state” — can be great for mental health. From pickleball to Sudoku puzzles, the options are endless!
- Do a daily “mind dump.” This exercise isn’t your typical daily journal. Once a day, spend 5 to 10 minutes getting all the racing, depressed, or angry thoughts down on paper. Make it messy. Then move on with your day.
- Stay ahead of basics that can bring discomfort. Eat consistent and nourishing meals, get enough sleep, drink water, and move your body. Taking care of yourself and avoiding things that can activate depression (feeling “hangry” is real) may help you avoid excessive anger.
- Channel your excess energy. You can get your energy out in health-promoting ways, such as swimming, hiking, or yoga. Exercise can also bring you back to your body and out of your head, which helps if you’re experiencing agitation or depressive thoughts.
Practice techniques for managing anger
Stop and self-calm. If you find the agitation building, try to take yourself out of the situation or find a quiet space. Find something to self-calm in these moments. You can experiment with deep breaths, taking a bath, or coloring.
Find ways to minimize or deescalate conflict. For example, if you’re communicating with someone and feel annoyed or downright angry, take a timeout before expressing yourself. You can also consider looking into cognitive behavioral therapy (CBT) techniques to manage thoughts before they snowball.
Talk with a therapist
Agitation in agitated depression is just a symptom. One of the best ways to help manage depression or bipolar disorder is through treatment with a mental health professional.
- help determine why you’re experiencing agitated depression and work with you on underlying causes
- practice coping strategies
- discuss medications that may support you through treatment
Although it’s not an official diagnosis, agitated depression is a term that describes many people’s experiences living with depression.
Relaxation and coping techniques can help minimize the effects of agitation. No matter what type of depression you’re living with, medications and psychotherapy can help keep depression and bipolar disorder from affecting your daily life.
Looking for mental health support, but not sure where to start? Psych Central’s How to Find Mental Health Support resource can help.
Feeling agitated doesn’t mean you aren’t living with depression. It’s possible sadness and despair may be affecting your life.
If you, or someone you know, are considering self-harm or suicide, you’re not alone. Help is available right now:
- Call the National Suicide Prevention Lifeline 24 hours a day at 800-273-8255.
- Text “HOME” to the Crisis Text Line at 741741.