Overview
Agitated depression is a subtype of major depressive disorder characterized by prominent agitation, irritability, and restlessness alongside depressive symptoms 1.Diagnosis
Presence of depressive symptoms (e.g., depressed mood, loss of interest) 1
Concurrent significant agitation or irritability 1
Exclusion of other causes of agitation (e.g., substance use, medical conditions) 1
No specific laboratory tests; diagnosis primarily clinical 1Management
First-line treatments: Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) 1
Adjunctive treatments: Atypical antipsychotics (e.g., quetiapine, aripiprazole) for severe agitation 1
Caution with metoclopramide: Monitor for development of tardive akathisia and agitated depression 1Special Populations
No specific guidance provided for pregnancy, pediatrics, elderly, or comorbidities in the given abstracts 1Key Recommendations
Consider SSRIs or SNRIs as first-line pharmacological treatments for agitated depression (Evidence: Moderate 1)
Monitor patients on metoclopramide for signs of tardive akathisia and agitated depression (Evidence: Weak 1)
Adjunctively use atypical antipsychotics if agitation is severe and not adequately managed with antidepressants (Evidence: Expert opinion 1)References
1 Shearer RM, Bownes IT, Curran P. Tardive akathisia and agitated depression during metoclopramide therapy. Acta psychiatrica Scandinavica 1984. link