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What is Agitated Depression? Dealing with Restlessness and Depression
Theodora Blanchfield
Typical media depictions of depression might lead you to believe that depression only presents as total apathy, sadness, and a lethargy that causes you to want to stay in bed all day. Yet up to 25 percent of people with depression actually experience agitated depression symptoms, which can be quite the opposite.
What is agitated depression, and how do its symptoms differ from other symptoms of depression? Agitated depression occurs most often in people with major depressive disorder, when they are having a major depressive episode. In many ways, these episodes may be similar to a typical major depressive episode, but if you're feeling particularly agitated, it's worth recognizing how that agitation relates to depression and how the right treatment could provide relief from your symptoms.
What Is Agitated Depression?
Agitated depression isn't an official diagnosis; it's simply a way of referring to a major depressive episode with symptoms that relate to agitation. Potential causes of agitated depression generally overlap with those of depression, which may include trauma, recurring stressors, genetic predisposition, or hormonal imbalances such as those caused by thyroid problems.
With agitated depression symptoms, you might find yourself snapping at your partner or feeling restless and frustrated regardless of the circumstances. For instance, a seemingly small stressor, like your roommate not doing the dishes, could cause you to become more upset than the situation warrants. You might feel too depressed to leave your house but also feel anxious and trapped while you are at home. These seemingly conflicting feelings may feel difficult and uncomfortable to reconcile. Other symptoms of agitated depression include irritability (especially over small things), anger, fidgeting, restlessness, pacing, and incessant talking.
Treatment for Agitated Depression
If the above symptoms seem like they apply to your situation, you may want to consult a doctor, especially if the symptoms are affecting your life significantly. Agitated depression symptoms can be associated with depressive episodes in both unipolar depression (depression without mania, also known as major depressive disorder) and bipolar disorder (characterized by depression and mania), so you will want to consult with a doctor to investigate whether you are experiencing one condition or the other to get a proper medical diagnosis. Agitated depression may also be called depression with mixed features, or a major depressive episode in which both manic symptoms and depressive symptoms occur.
Treatment for agitated depression usually includes medication, talk therapy, or some combination thereof. While a major depressive disorder diagnosis is generally treated with antidepressants, agitated depression—especially if it accompanies a bipolar diagnosis—may be treated with mood stabilizers, antipsychotics or anti-anxiety medications. A mood stabilizer can help to reduce the drastic swings between lethargy and agitation, while an anti-anxiety medication can provide some relief from the physical symptoms of anxiety or agitation, such as tense muscles or a racing heartbeat. Cognitive behavioral therapy (CBT) may also be used to find healthier ways of coping with irritation.
Other Options for Treatment
If you have tried one or several medications and haven't found relief yet, there is good reason to remain hopeful and persist in your search for a working treatment. In fact, only about 30% of people find the right medication for them on the first try. In some cases, your current medication might even be causing your agitation, which could mean that a different treatment may be better for you.
There are also options you could consider beyond medication. For example,
transcranial magnetic stimulation, or TMS, is a treatment that has proven effective for many people who still experience depression symptoms after trying medication and talk therapy treatments. With TMS, magnetic pulses gently stimulate regions of the brain responsible for regulating mood. Unlike other non-medication treatment options, TMS is non-invasive, and the sessions tend to be short, with each one lasting only 30 minutes or less. Another bonus of TMS is that the side effects are minimal and usually dissipate quickly after the session. Agitated depression can feel like an inner tug-of-war, but the condition is treatable. With the right treatment, you can find relief from your depression symptoms and enjoy a more peaceful life.
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Starting any medical treatment for the first time can leave you with questions, especially if you’re looking forward to the benefits it may bring. It’s no different when you’re preparing for your nasal esketamine treatment. Your previous mental health treatments may have consisted solely of taking antidepressants at home or visiting a therapist’s office for cognitive behavioral therapy (CBT), so nasal esketamine is probably a new treatment experience for you. If you're wondering what it's like to start nasal esketamine and get ready for your first session, keep reading. Getting Started with the Nasal Esketamine Treatment As with any new treatment, you’ll first talk to your primary care provider or psychiatrist about whether nasal esketamine is a good fit for you. Alternatively, you can schedule your esketamine nasal spray consultation with a treatment center (such as Greenbrook) that has certification by the FDA’s Risk Evaluation and Mitigation Strategy (REMS). At Greenbrook's REMS-certified nasal esketamine treatment centers, our Greenbrook-affiliated psychiatrists and psychiatric nurse practitioners will review your medical history and also conduct our own assessment to help determine whether nasal esketamine treatment is right for you. Certain conditions, including blood vessel disease and a history of psychosis, may make treatment a risk for you. Make sure you discuss all previous and present conditions with your doctor or nasal esketamine provider before beginning treatment. If the medication is deemed a good fit, you’ll receive your prescription from the Greenbrook-affiliated provider. Your Greenbrook Care Team will put together a personalized care plan for the weeks and months to follow. Keep in mind that you will need to take a standard (oral) antidepressant along with your nasal esketamine treatment. There are two important regulations to note when it comes to preparing for treatment: Each treatment is followed by a mandatory two-hour observation period. This means you will need to plan to stay at the center for at least two hours following your self-administration of the esketamine nasal spray. You cannot drive during the rest of the day after treatment and must arrange for transportation. These regulations are mandatory. It may be helpful to sit down and plan out several weeks’ worth of transportation once you know your treatment schedule. In addition, if you’re wondering what to bring for the treatment, we recommend entertainment such as an audiobook or playlist of favorite songs and a pair of headphones. You may want them during the two-hour observation period. What to Expect During Nasal Esketamine Treatment On the day of treatment, you’ll need to stop eating any food two hours before your appointment and stop drinking all fluids 30 minutes before you come in. Your Greenbrook Care Team will confirm that you are prepared for the two-hour observation period and that you have a ride home. You’ll get the opportunity to practice using a “trainer sprayer” that mimics the real nasal esketamine sprayer but does not release any medication. The Care Team will encourage you to use the restroom and set up your preferred environment in your private treatment bay or room. Some patients like reduced lighting, for example, while others don’t request light adjustments. You’ll complete a depression scale before each treatment session. Your Greenbrook provider will confirm that the dose kit is yours, show you how to administer it, and then hand it to you. Each sprayer contained 28mg of Spravato esketamine nasal spray. Patients usually start with two sprayers (56mg) and soon increase to 84mg (three sprayers) per treatment. But, your dosage maybe vary. Should you be left with a metallic taste by the spray, the Care Team will offer suckers to help make the flavor dissipate. After your dose, you’ll be encouraged to lie back in your comfortable recliner. While most patients enjoy a quiet setting, Greenbrook is prepared to accommodate patients with a more animated reaction to the medication. You may feel sleepy, dizzy, mildly dissociated, and/or nauseated during treatment. Greenbrook's Care Team is readily available if you need assistance. How to Prepare for after your Nasal Esketamine Treatment Most side effects begin to wane in the second hour of observation, but if you’re wondering, “Is it safe to drive immediately after nasal esketamine treatment?” the answer is a resounding no. In addition to the mandatory ride home, you will need to block off time to rest and let side effects fully dissipate. This extended rest period is especially important in the first weeks of treatment when you’ll have treatment twice a week. Do not drive or operate machinery of any kind until the day after treatment. Just take it easy, relax, and take care of yourself. If you’re unsure what activities you can do or should avoid during this time, talk to your Care Team for more information. While side effects tend to dissipate completely after a good night’s sleep, many nasal esketamine patients begin feeling relief from depression symptoms within hours of their treatment. Other Tips in Preparing for Your Nasal Esketamine Treatment At Greenbrook, we make every effort to schedule your treatment in the afternoons or whenever it is most convenient for you. We encourage you to see each treatment session as an opportunity to relax and take care of your mental health. If you have any questions or concerns, talk to your doctor or the Greenbrook Care Team. At Greenbrook, we’ll help you feel at ease when preparing for each treatment session. Schedule A Free Consultation To get started with nasal esketamine, schedule your free consultation today.
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