What is the difference between agitated depression and mixed bipolar episodes?

Question

Hello doctor,

I am a 31-year-old female. After years of knowing that I need help, I finally went for a psychiatric assessment last week, but I had a bad experience. The psychiatrist and the nurse present in the assessment made it abundantly clear that they were short on time from the get-go, and they only spoke with me for half an hour before rushing me out with a prescription for antidepressants. The psychiatrist said that I have "agitated depression". I had never heard of this form of depression before, so I have been reading a lot about it ever since the diagnosis to learn more about it. I can see why he thinks that because I have a couple of symptoms, but when I read what people said agitated depression "feels like" for them, I cannot relate at all. It is not what I have actually experienced. I do not feel restless, pace, pull my hair, fidget, etc. I only feel insomnia when I feel great, which only happens once in a while. I get irritated sometimes with people or music, but I do not lash out or feel angry.

During my quest to understand my diagnosis, I came across descriptions of "bipolar disorder", and I found that I completely relate to what people say they experience with bipolar. I did not know much about it until now, but I have been thinking back and I am pretty sure my mood has been cycling between major depressive episodes and manic or hypomanic episodes (not sure which, I relate symptoms of both mania and hypomania). In addition, I believe I have been experiencing a lot of "mixed episodes" dispersed between the highs and the lows. Can you please explain the clear difference between agitated depression and mixed bipolar episodes? I did not realize until now that my energy levels, thoughts, and behaviors closely reflect some type of bipolar disorder. I always just thought I was depressed most of the time with some instances of feeling really good (usually four days up to three weeks). I have almost every sign and symptom of bipolar, whereas only a few of the agitated depression signs and symptoms.

I am worried because I started on 30 mg of Mirtazapine three days ago and I was super groggy and tired the first day but now I feel absolutely wired. Is it possible that I was misdiagnosed? If so, what should I do? I think I just need to know the difference between the two disorders. I do not have a follow-up appointment for another three weeks and I am afraid that I am taking pills I should not be taking.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understand your concern.

Agitated depression is a subtype of depression though it is not a diagnosis in the DSM (diagnostic and statistical manual of mental disorders) and ICD-10 (international classification of diseases). It actually refers to depression with agitation, that is, extreme anxiety or apprehension. In it, the patient feels restless, and sometimes tries to feel better by working a lot but is usually unable to complete a task. Bipolar disorder, on the other hand, is a disorder characterized by both depressive episodes (at least for two weeks) and manic or hypomanic episodes (at least for a week). Mixed mood disorder has symptoms of both depression and hypomania. In fact, agitated depression is somewhat linked to the bipolar spectrum. In the first visit usually, a differential is made and a final diagnosis needs subsequent visits. In my opinion, your psychiatrist has started the tablet Mirtazapine (tetracyclic antidepressant) as it helps with both depression and anxiety, your current symptoms, and it takes around two to three weeks to exert its effect. In my opinion, you can continue with it.

I hope this helps you.

Thank you for consulting me.

You can always come back and reach me at icliniq.com.

What is the difference between agitated depression and mixed bipolar episodes?

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