Depression tends to involve feelings of 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 the combination of anxiety and depression.

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.

Symptoms of depression and agitation

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) lists criteria to help a doctor diagnose various mental health conditions.

Depression

For a diagnosis of depression, a person needs to have experienced low mood or a 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

Learn more about the symptoms of depression.

Agitation

Symptoms of agitation:

• 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, ranging from a nagging sense of unease to aggression.

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

Frequent agitation can affect a person’s:

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

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

• Ask the tough question: “Are you considering suicide?”
• Listen to the person without judgment.
• Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
• Stay with the person until professional help arrives.
• Try to remove any weapons, medications, or other potentially harmful objects if it’s safe to do so.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.

Find more links and local resources.

Causes of agitation in depression

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

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

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

• being in a new environment
• substance use or withdrawal
• physical health conditions

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

• infections, including sepsis
• dementia
• endocrine problems
• exposure to toxins
• an 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 in other conditions

Agitation often occurs alongside depression, but it can also be a feature of other mental health conditions — some of which also involve depression. Those conditions include:

• bipolar disorder
• schizophrenia
• traumatic brain injury
• autism spectrum disorder
• anxiety disorders
• seizure disorders

Bipolar disorder

Bipolar disorder has many features, but one of the key symptoms is mood changes. Agitation, or agitated depression, may have 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 often has links to symptoms of the condition, such as disturbing auditory hallucinations.

Learn more about the symptoms of schizophrenia.

How is agitation in depression diagnosed?

If agitation is making daily life difficult or if someone is at risk of harming themselves or someone else, they need to speak with 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-TR can help a doctor diagnose depression or another mental health condition, but they do not address agitation or agitated depression.

Treatment for agitation and depression

Various approaches can help a person with agitated depression. We discuss these in more detail here.

Sedative medications

Doctors typically prescribe sedative medications only in severe cases of agitation. These medications may help calm a person quickly and 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 medication. They may prescribe an anti-anxiety medication or a mood stabilizer, depending on the diagnosis.

Antidepressants can take 2 to 4 weeksTrusted Source to start working. A person may need to continue taking them for 9 to 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 with a trusted person about any increasing feelings of agitation. They may be able to help de-escalate the situation.
• Notice thirst, hunger, or any other feelings of discomfort.

Stress relieving techniques

Tips for relieving stress, anxiety, and depression include:

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

There is no 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 can persevere with their treatment plan as much as possible and speak with a doctor if they feel that, after some effort, it is not working.

My best friend has bipolar disorder and stopped taking their medication, as they said it did not suit them. Their agitation scares me and creates a lot of tension. What should I do?

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