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'Agitated depression' is a term used to refer to a specific type of mixed episode (mood disorder) where Depressive symptoms are occurring in addition to some hypomanic symptoms. Mixed episodes are generally considered to indicate a serious mood disorder has developed.
The symptoms of agitated depression can vary from person to person but generally there should be significant Depressive symptoms (depressed/low mood, anhedonia, sleep disturbance, loss of energy, low motivation, cognitive impairment, etc) and also some hypomanic symptoms (usually agitation, irritability, anxiety, etc).
Agitated Depression is diagnosed in the same way the majority of mental illnesses are diagnosed; by clinical interview and assessment. A clinical assessment can involve gathering a range of relevant information (usually information the confirms or discounts the presence of specific symptoms) from the patient and also sometimes other family members, friends or work colleagues. A diagnosis is simply a persons opinion, nothing more. So, when I make a diagnosis I am making a formal declaration of my opinion on my patients psychological status. As a diagnosis is only an opinion a mental health nurse can make a diagnosis but as a general statement psychiatric diagnoses are usually made by Psychiatrists or Clinical Psychologists. While there are undoubtedly Psychiatric Nurses who are very knowledgeable and are good at making a diagnosis´s I would generally recommend that you get a second opinion from either a Psychiatrist or a Clin. Psychologist.
I hope this has been of some help. Please let me know if you have further questions or would like me to clarify any part of my answer.
Thank you for your response. One more question please?
I have recently noticed that I was diagnosed with aggitated depression in 2003. When I read this diagnosis, I took it to mean 'depression' caused by stress. However, I recently learnt what the symptoms of 'aggitated depression' are and I am sure that I did not have or describe the majority of these symptoms to the nurse when I saw him.
I believe the nurse's diagnosis was incorrect and I would appreciate it if you could tell me if his letter seems right to reach a diagnosis of aggitated depression.
I have highlighted the symptoms that I remember telling the nurse. Please note, the letter says I denied panic attacks. I do remember having my first panic attack around the time that I saw the nurse but I cannot specifically remember him asking me about this.
The nurse's letter is as follows;
The above named made a self referral by walking into our health centre to be seen as an emergency case today. His main complaint is that he is anxious and agitated for no apparent reason.
During the interview he complained of depression and low mood. He lacks motivation and both his concentration and memory are poor. He has difficulty in going to sleep and whenever he sleeps he tends to wake up at 3 or 4 a.m. and cannot not go back to sleep. He denies any suicidal ideas and feels life is worth living. He said that he is fatigued but cannot rest as he is anxious and agitated. He denies any panic attacks.
Mr Precilla does not present any signs or symptoms of psychotic behaviour. He denies any hallucination, delusion or illusion, no flight of ideas noted. He is well orientated to place, time and person. His speech is clear, coherent and good volume. He was well dressed for the weather and both his behaviour and manners were good.
Furthermore, Mr Precilla said that he was very stressed while working for the MOD as an engineer. He did not get on with his first line manager and he was transferred to the computer section where he had to work on his own in a single small room and did not see the daylight. He became depressed and anxious. Also finding accommodation in Cambridge put a lot pressure on him. He could not cope with the work at MOD. He became suspicious of people around him and he had to resign and take a job at London Transport. He bought a house in London and found that the mortgage of £900 per month is too much for him to pay. He said that this is another stress on top of his depression and problems. He has moved in with his brother and rented his own house to pay the mortgage.
Whenever he is in trouble, his family help him and now he realises he is putting a lot of pressure on his relatives. He feels insecure and lacks confidence. He expressed a lot of somatic illness such as headache, pain in the shoulder and chest, etc.
He does not have any past mental health history and he denies any forensic history. He does not smoke but admitted to drinking 3 – 4 pints of lager at the weekend. He denies abusing any illicit drugs. He does not have any relationship and his last girlfriend was 1 year ago having been together for 8 months.
I feel that this patient suffers from agitated depression related to stress. His Lustral
tablet of 50 mgs should be increased to 100 mgs (therapeutic dose) for a period of 6
weeks, then reduce the dose back to 50 mgs with a view to stopping it in a few weeks.
I have asked him to see you with regard to referring him to your local Psychotherapy Department for some counselling. I am afraid I cannot supply him with this service as he lives outside our catchment area.
Community Mental Health Nurse
Does this letter seem right?
Based on the information contained in his letter I would not presume agitated depression but rather a mixed Depressive/Anxiety condition. I would base this primarily on the fact that the letter does not appear to describe any hypo manic symptoms. I also note that he recommends increasing the dosage of an SSRI, something you certainly wouldn't do if a person was displaying manic or hypo manic symptoms.
I obviously can't know this persons intentions but if I had to take a guess I'd say he's just used the wrong terminology and used 'Agitated Depression' to describe the presence of both Depressive and Anxiety symptoms.
Not necessarily. It would depend on the severity of the specific symptoms. If a person was experiencing mild Depressive symptoms and mild anxiety symptoms it would not usually be considered t be a sever psychiatric illness. If the person was experiencing more sever symptoms (for example if they were intensely suicidal) then they would usually be considered to be severely unwell.
Based on the information contained in the report I would not have thought it was a situation of 'severe psychiatric illness'.