What Is "Agitated" Depression?

Written by Seth Meyers, Psy.D.

If you like this article, check out my podcast INSIGHT with Dr. Seth here, which is available on Spotify, Apple Podcasts, and YouTube.

Depression is one of the most common mental health disorders experienced by adults, yet the symptoms experienced by its sufferers may vary significantly. It's common to associate depression with the stereotypical presentation of it in film and on TV, so it's important to note some of the other forms depression can take.

To begin, take a moment and think about how you define depression. Specifically, visualize someone you imagine is depressed. Ask yourself how they may move or walk, what some of their daily routines may look like, and whether you imagine them being active and functional socially. Do you imagine, for example, that a depressed person is quiet and negativistic, cries often, and spends a lot of time sleeping, even in the middle of the day?

It's a myth that depression is always a passive and withdrawn or depleted experience for the sufferer. Many individuals who suffer from depression have depression which is an agitated version of the disorder. While traditional depression symptoms can be present, many of the typical symptoms of depression exist along with an agitated state.

Is Agitated Depression a Different Diagnosis?

The diagnosis for someone with agitated depression still falls under the general diagnosis of major depressive disorder, as defined in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5; American Psychiatric Association, 2013). It's important to note that of the eight possible criteria included, only five must be met to meet the diagnosis, and those criteria must be met for a period of two weeks or longer. Though one of the eight criteria is a depressed mood, that particular criterion is not required to have a depression diagnosis.

What Does Agitated Depression Look Like in Everyday Life?

• Mood: In a mood disorder, by definition, the mood of the sufferer interferes with positive and consistent daily functioning at home, at work, and in close relationships. With agitated depression, the mood may be irritable or change from moment to moment.
• Movement and energy: The individual's energy and movement may be off, taking the form of higher energy and increased movement. The individual may be restless, may pace, or be overly active, or they may be overly talkative and present a flight of thoughts or ideas.
• Aggressive behavior or outbursts: The individual may also be more verbally or physically aggressive than usual, and may display impulsive behavior or angry outbursts. It may seem to others as if the individual is looking to start a conflict or flight, and can't seem to self-soothe in a healthy, normal way.

Agitated Depression in Children

As a psychologist, I can share anecdotally that many mental health professionals and physicians who treat children note that kids who are depressed often appear to have more irritable mood and active or inconsistent behavior, as opposed to having the traditional symptoms of sadness, withdrawal, and isolation.

Overall, recent research has found that approximately 2.4 million children, or 4 percent, had been diagnosed with depression (Lebrun-Harris, Ghandour, Kogan, and Warren, 2022). It’s crucial to note that this statistic only includes the children who were diagnosed, meaning that many other children may be suffering but haven't yet been diagnosed.

It’s also important to note that, because depression may appear as agitation in some children, a child’s true depressive symptoms may be misperceived. Their possible depression may not be assessed as a result.

How to Treat Agitated Depression

Any depression that reaches the level of significant impairment in daily functioning for two weeks or longer should lead to consultation with a health professional, and that professional can direct one to appropriate places for treatment.

Among the most effective treatments for depression is cognitive behavior therapy (CBT), a type of therapy for which the vast majority of licensed mental health professionals have received training. Research shows that CBT is not only efficacious in the acute treatment of depression, but that it also appears to have an enduring effect that protects against subsequent relapse and recurrence of the depression (Driessen and Hollon, 2011).

In order to know whether a mental health provider is able to provide this type of treatment, it’s important to ask specific questions. Consider asking any of the following questions: Is CBT something you practice often to treat patients? Can you give me examples of how you will use the session time? How many sessions do you typically need to treat depression?

Education is a crucial component of seeking out and receiving mental health treatment. In addition, active engagement in the work of treatment in between sessions can bring greater improvement in depression symptoms. CBT will typically draw on assignments and tasks to work on in between sessions, and these are highly recommended to lead to successful results.

Anyone suffering from severe depression or having suicidal thoughts can get immediate support from the National Suicide Lifeline by texting or calling 988. Otherwise, call your local mental health clinic for services or do a web search for mental health services in your area.

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Driessen E, Hollon SD. Cognitive behavior therapy for mood disorders: efficacy, moderators and mediators. Psychiatric Clinics of North America. 2010; Sept;33(3):537-55.

Lebrun-Harris LA, Ghandour RM, Kogan MD, Warren MD. Five-Year Trends in US Children’s Health and Well-being, 2016-2020. JAMA Pediatrics. 2022;176(7):e220056.

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Are Long Distance Relationships Actually Better and Closer In Some Ways?

Written by Seth Meyers, Psy.D.

If you like this article, check out my podcast INSIGHT with Dr. Seth here!

Many individuals swear off potential long-distance relationships due to the belief that they are too difficult and frustrating.

Basic obstacles in a long-distance relationship

Long-distance relationships come with clear obstacles. For one, there is the inability to be together in person every day or several days per week, and many couples enjoy spending time together on a regular and frequent basis. Long-distance relationships make physical affection a challenge, too, as they miss the constancy of gestures as small as hand-holding to more physically intense behaviors, such as sexual experiences.

Adding to these challenges are the emotional ones that sometimes befall long-distance relationships. Individuals who are prone to insecurity or jealousy may find themselves questioning and wondering about what their partner is doing when they're on their own, and these insecurities can often lead to larger feelings of distrust and verbal conflicts in a relationship. Loneliness is a factor, too, as some end up feeling deprived of time and attention from someone whose love and care they crave. 

Given the factors described above, the challenges are evident. However, some research casts a wildly different perspective and suggests that there may be a unique benefit from them when it comes to emotional intimacy. 

Research suggests some unique benefits

Research from Jiang and Hancock in the Journal of Communication (2013) was designed to observe what exactly happens in long-distance relational communication, particularly when compared to geographically close ones. The study found that the emotional connections felt in long-distance relationships may be equally strong or stronger than their counterparts who are geographically close. Specifically, the diary study tested an intimacy-enhancing process and found that long-distance couples engage in more adaptive self-disclosures and form more idealized relationship perceptions than do geographically close couples across various interpersonal media. 

In particular, the finding regarding adaptive self-disclosures makes sense on an intuitive basis. Because long-distance couples who live farther apart don't have the same physical connection to "rest on," these couples must actively work harder to first develop and then sustain emotional bonds to hold them together. Self-disclosure is important for the emotional intimacy level of any relationship, but self-disclosure may be a key to the success of a long-distance relationship; moreover, it's possible that more self-disclosure is a necessity for a long-distance relationship to counteract the inherent obstacles. 

Practical tips if you're in a long-distance relationship

If you're considering a long-distance relationship or are already in one, be vigilant about practicing particular behaviors that foster a sense of closeness.

• Regular and multidimensional communication: Regular communication is especially important in long-distance relationships, but creative and multidimensional communication is just as important. Connecting virtually or by phone video can bring a greater sense of closeness than simply using the phone, and texting and emailing can help to bring a sense of immediate connection throughout the day.
• Writing letters: Something few couples do who live in the same location is write letters to each other, but being apart physically allows for a more thoughtful and deliberate way to communicate one's thoughts and feelings. Writing is a good mental health exercise for anyone, but writing a letter to a romantic partner encourages the writer to be more emotionally expressive than they may be prone to in regular conversation. In addition, receiving a letter from a partner can feel like a uniquely special experience, increasing the sense of emotional intimacy in the relationship.
• Having a "fears discussion": Finally, because long distance inevitably creates challenges that geographically close relationships don't have, the couple should agree to honestly convey any fears that come up with the other member of the couple. Fears about finding someone else or waiting too long to make a move where they are both in the same location are normal and should be expressed for both members of the couple to listen to the other and work through any anxieties or insecurities together.

Conclusion

As with many psychological phenomena, it's important to remember that the quality and success of long-distance and geographically close relationships will always depend on the members in each couple rather than norms reflected in the population or in psychology studies. In other words, a couple trying to make a relationship work successfully has the chance and capacity to make the relationship meaningful, satisfying, and lasting as long as they are both committed to making it work and adaptive as the relationship grows and changes. Research, including the study cited, serves as an important reminder about particular factors couples who embark on and seek to maintain a long-distance relationship should consider to promote the most successful outcome.