Frustrated Depression: Identifying Signs, Root Causes, and Remedies

Frustrated Mood Disorder: Identifying Signs, Origins, and Remedies

Depression often brings feelings of despair, sadness, or powerlessness, but some individuals experience agitation instead. This agitation can manifest as signs of anxiety and restlessness.

While 'agitated depression' isn't a recognized medical term, people use it to describe the blend of anxiety and depression.

Agitation is a symptom that can appear in major depression, bipolar disorder, and schizophrenia.

This article delves deeper into agitation, its effects, and what to do if it arises.

Symptoms of Depression and Agitation

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR), provides criteria to aid in diagnosing various mental health conditions.

For a depression diagnosis, an individual must have experienced persistent low mood or a loss of interest in activities for at least 2 weeks. They should also display at least five of the following symptoms:

Nearly every day, experience feelings of sadness, hopelessness, or irritability.
Almost every day, lose interest or pleasure in activities.
Within a month, significant weight loss or drastic changes in appetite lead to a 5% change in body weight.
Sleep patterns are disturbed—either too much sleep or insufficient sleep.
Psychomotor agitation or restlessness is evident.
Difficulty sitting still or feeling "slowed down."
Nearly every day, fatigue or lack of energy prevails.
Feelings of worthlessness or excessive guilt almost every day.
Difficulty thinking clearly, concentrating, or making routine decisions.
Frequent ideas of death, self-harm, or suicide.

Learn more about depression symptoms.

Agitation's Symptoms

Symptoms of agitation include:

Frequent outbursts of anger.
Impulsive or disruptive behavior.
Excessive talking or movement.
Trouble sitting still.
Concentration or communication difficulties.
Pacing or shuffling the feet.
Tension, anxiety, and irritability.
Hand-wringing or clenched fists.

Symptoms can appear suddenly or gradually, ranging from a mild unease to aggressive behavior.

Persistent agitation can affect an individual's:

Interpersonal relationships.
Performance at work or school.
Overall health and safety.

Seeking Help

If you or someone you know is in crisis, considering suicide or self-harm, please seek support:

Call or text the 988 Lifeline at 988 or chat at 988lifeline.org. Caring counselors are available to listen and offer free, confidential support 24/7.
Text HOME to the Crisis Text Line at 741741 to connect with a volunteer crisis counselor for free, confidential support 24/7.
Not in the United States? Find a helpline in your country with Befrienders Worldwide.
Call 911 or your local emergency services number if you feel safe to do so.

If you're calling on behalf of someone else, stay with them until help arrives. You can remove harmful substances or weapons if it's safe to do so.

If you're not in the same household, stay on the phone with them until help arrives.

Causes of Agitation in Depression

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

Depression's causes may be due to biological, genetic, environmental, and psychological factors.

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

Being in a new environment.
Substance use or withdrawal.
Physical health conditions.

Medical conditions that can increase the risk of agitation include:

Infections, such as sepsis.
Dementia.
Endocrine issues.
Exposure to toxins.
Electrolyte imbalance.

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

In many cases, it's not clear why agitation develops.

Agitation in Other Conditions

Agitation often coexists with depression, but it can also be a characteristic of other mental health conditions that involve depression. These include:

Bipolar disorder.
Schizophrenia.
Traumatic brain injury.
Autism spectrum disorder.
Anxiety disorders.
Seizure disorders.

Bipolar Disorder

Bipolar disorder manifests various features, but a key symptom is mood changes. Agitation, or agitated depression, can occur with this condition.

Bipolar disorder can involve transitions between low and high moods, known as mixed states. Some individuals experience hypomania, a high mood that is less severe 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 linked 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 disrupts daily life or places someone at risk of harming themselves or others, they should speak to a doctor. A loved one may help them understand the importance of this conversation.

A doctor will ask about the symptoms the individual is experiencing, such as:

When did the symptoms start?
What triggers or eases the symptoms?
Have alcohol or other substance use patterns changed?

Sometimes, a loved one can provide insight by pointing out changes or patterns in a person's behavior.

Criteria from the DSM-5-TR are effective in diagnosing depression and other mental health issues, but they don't cater to addressing issues related to agitation or agitated depression.

Treatment for Agitation and Depression

Different methods can be beneficial for an individual dealing with agitated depression. Let's delve deeper into these treatments.

Sedative Medications

Doctors usually prescribe sedative medications in severe cases of agitation. These medications can momentarily calm a person and provide instant relief.

Antidepressant Medication

Doctors might recommend various antidepressants to combat depression. If the medications aren't effective, the doctor may adjust the drug, add another medication, or prescribe an anti-anxiety drug or mood stabilizer.

Antidepressants can take some time to start working, and a person might need to continue taking them for 9 to 12 months.

Counseling

An experienced and qualified counselor can help an individual identify thoughts and feelings that could hint at the onset of agitation or depressive symptoms.

Counseling can aid in focusing on thoughts and actions that can bring about a sense of well-being during periods of agitated depression.

Self-help Tips

Some self-help tips that can be beneficial for individuals experiencing agitation include:

Taking a break. For example, going for a walk outside.
Talking to a trusted person about any increasing feelings of agitation. They might be able to help deescalate the situation.
Paying attention to any discomfort, like thirst or hunger.

Stress Relief Techniques

Stress-reduction techniques include:

Regular physical activity
A well-balanced diet
Good sleeping habits
Meditation
Deep breathing exercises
Spending enjoyable time with friends
Gardening or spending time in the open air
Journaling

Every individual's path to relieving agitated depression will be unique. A doctor will likely advocate for a combination of medication and counseling as the most effective approach.

Finding the right mix of medications, therapy, and stress-relief techniques can take time and may require adjustments along the way. Individuals should persist with their treatment plan, but if they feel it isn't working after some effort, they should consult with their doctor.

My Best Friend's Situation

My best friend has bipolar disorder and has stopped taking their medication, claiming it doesn't suit them. Their agitated behavior is alarming and creates tension. What should I do?

Dealing with this situation can be challenging, and there isn't a one-size-fits-all solution. Communication is crucial. Wait until your friend is not agitated and their symptoms have stabilized. During these times, share your concerns with them and express how their agitated behavior affects you when they stop taking their medication.

Being open and honest with your friend is essential. Remind them that if they dislike how the medications affect them, they should discuss this with their prescriber. Share your observations of their behavioral changes when they stop taking medication.

If you continue to feel unsafe, prioritize your well-being. This may involve limiting your contact with your friend during agitated periods, or if things worsen, considering ending the friendship to ensure your safety.

— Timothy J. Legg, PhD, CRNP

Agitation is a symptom that can appear in various mental health conditions, such as major depression, bipolar disorder, and schizophrenia, as stated in the text.
Antidepressant medication is sometimes prescribed to combat depression, but they may need to be adjusted, added to, or replaced with an anti-anxiety drug or mood stabilizer if they're not effective, as discussed in the treatment section.
According to the DSM-5-TR, for a depression diagnosis, an individual must have experienced persistent low mood or a loss of interest in activities for at least 2 weeks and display at least five symptoms, including psychomotor agitation or restlessness, as mentioned in the Depression Symptoms section.
Agitation is not a disorder in itself but can be a symptom of mental health conditions like bipolar disorder and schizophrenia, as explained in the Causes of Agitation in Depression section.
Seeking help is crucial when dealing with agitation, and resources such as the 988 Lifeline, Crisis Text Line, and Befrienders Worldwide are available for individuals in crisis, as outlined in the Seeking Help section.