7 - Agitated depression: spontaneous and induced  pp. 157-186

Agitated depression: spontaneous and induced

By Athanasios Koukopoulos et al.

Chapter Abstract

Depression is understood as a morbid entity and every physician is entitled to offer antidepressant treatment to nearly all patients with despondent mood diagnosed as meeting the DSM-III criteria for a major depressive episode with or without agitation. Normal human behavior, and especially behavior during affective episodes, has created the impression that good mood is allied with good drive and fluent thinking and vice versa. Hypomania with euphoric mood with hyperactivity, and depression with retardation are typical examples of this parallelism. It is ironic that today agitated depression has lost its status as a mixed state, whereas manic stupor and dysphoric mania are still considered as such. Clinical forms of agitated depression include psychotic agitated depression, agitated depression with psychomotor agitation, and minor agitated depression. The anxiety observed in agitated depression seems to be of a different kind, inherent in the agitation itself.


major depressive episode; dysphoric mania; mixed state; hypomania; inner agitation; agitated depression; psychomotor agitation;
Akiskal, H. S. (1992). The distinctive mixed states of bipolar I, II, and III. Clin. Neuropharmacol., 15 (suppl. 1), 632A–3A.
Akiskal, H. S., Hantouche E. G., Bourgeois, M. L. et al. (1998). Gender, temperament, and the clinical picture in dysphoric mixed mania: findings from a French national study (EPIMAN). J. Affect. Disord., 50, 175–86.
American Psychiatric Association (1968). Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association.
American Psychiatric Association (1980). Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association.
American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association.
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association.
Aretaeus Cappadox (1735). De Causis et Signis Morborum. Lugduni Batavorum: Janssonios Vander.
Aristotle (1970). On the Soul. London: Harvard University Press.
Benazzi, F. (2000). Depressive mixed states: unipolar and bipolar II. Eur. Arch. Psychiatry Clin. Neurosci., 250, 249–53.
Boissier de la Croix de Sauvages, F. (1768). Nosologia Methodica sistens Morborum Classes: juxtá Sydenhami Mentem et Botanicorum Ordinem. Amstelodami: Tournes.
Bourgeois, M., Verdoux, H., Mainard, C. H. et al. (1995). Dysphoric mania and mixed states. Encephale, 21, 21–32.
Braden, W. and Qualls, C. B. (1979). Racing thoughts in depressed patients. J.Clin. Psychiatry, 40, 336–9.
Carlson, G. A. and Goodwin, F. K. (1973). The stages of mania. A longitudinal analysis of the manic episode. Arch. Gen. Psychiatry, 28, 221–8.
Clouston, T. S. (1888). Clinical Lectures on Mental Diseases. London: J. & A. Churchill.
Cullen, W. (1785a). Synopsis Nosologiae Methodicae: Exhibens Clariss, Virorum Sauvagesii, Linnaei, Vogelii, Sagari, et MacBridii, Systemata Nosologica. Edinburgh: William Creech.
Cullen, W. (1785b). Institutions of medicine for the use of the students in the University of Edinburgh. Edinburgh: Charles Elliot, T. Cadell.
Day, R. K. (1999). Psychomotor agitation: poorly defined and badly measured. J. Affect. Disord., 55, 89–98.
Dell'Osso, L., Placidi, G. F., Nassi, R. et al. (1991). The manic-depressive mixed state: familial, temperamental and psychopathologic characteristics in 108 female inpatients. Eur. Arch. Psychiatry Clin. Neurosci., 240, 234–9.
Drake, R. E. and Ehrlich, J. (1985). Suicide attempts associated with akathisia. Am. J. Psychiatry, 142, 499–501.
Dreyfus, G. L. (1907). Die Melancholie, ein Zustandsbild des manisch-depressiven Irreseins. Jena: G. Fischer.
Erfurth, A., Michael, N., Grunze, H., et al. (2001). Diagnosis and treatment of bipolar depression. Psychiatr. Fenn., 32 (suppl. 1), 33–43.
Esquirol, E. (1838). Des Maladies Mentales Considérées sous les Rapports Médicale, Hygiénique et Médico-légal. Paris: J. -B. Baillière.
Falret, J. P. (1851). Marche de la folie. Gazette ds H.p, Paris, 14 January, 24.
Fawcett, J., Clark, D. C., Busch, K. A. et al. (1993). Assessing and treating the patient at risk for suicide. Psychiatr. Ann., 23, 244–54.
Flemming, C. F. (1844). Ueber Classification der Seelentoerungen. Allg. Ztschr. Psychiatr., 1, 97–130.
Frances, A., Brown, R. P., Koesis, J. H. et al. (1981). Psychotic depression: a separate entity? Am. J. Psychiatry, 138, 831–3.
Glassman, A. H., Kantor, S. J., Shostak, M. et al. (1975). Depression, delusions, and drug response. Am. J. Psychiatry, 132, 716–19.
Goodwin, F. K. and Jamison, K. R. (1990). Manic-Depressive Illness. New York: Oxford University Press.
Griesinger, W. (1845). Pathologie und Therapie der psychischen Krankheiten. Stuttgart: Adolf Krabbe Verlag.
Griesinger, W. (1861). Pathologie und Therapie der psychischen Krankheiten. Stuttgart: Adolf Krabbe Verlag.
Gruber, N. P., Dilsaver, S. C., Shoaib, A. M. et al. (2000). ECT in mixed affective states: a case series. J. Ect., 16, 183–8.
Guislain, J. (1852). Traite sur les Phrenopathies. Gand: Hebbelynck.
Healy, D. (1994). The fluoxetine and suicide controversy: a review of the evidence. CNS Drugs, 1, 223–31.
Heinroth, J. C. A. (1818). Lehrbuch der Stroerungen des Seelenlebens. Leipzig: Vogel.
Himmelhoch, J. M., Coble, P., Kupfer, K. J. et al. (1976a). Agitated psychotic depression associated with severe hypomanic episodes: a rare syndrome. Am. J. Psychiatry, 133, 765–71.
Himmelhoch, J. M., Mulla, D., Nell, J. F. et al. (1976b). Incidence and significance of mixed affective states in a bipolar population, Arch. Gen. Psychiatry, 33, 1062–6.
Hippocrates (1988). Diseases II, para 72. Cambridge, MA: Harvard University Press.
Jamison, K. R. (1995). An Unquiet Mind. New York: A. A. Knopf.
Jaspers, K. (1923). Allgemeine Psychopathologie: für Studierende, Ärzte und Psychologen. Berlin: Verlag von J. Springer.
Kahlbaum, K. L. (1863). Die Gruppierung der psychischen Krankheiten und die Eintheilung der Seelenstoerungen. Danzig: Kafemann.
Kant, I. (1800). Anthropologie in pragmatischer Hinsicht. Königsberg: F. Nicolovius.
Klein, D. F. and Liebowitz, M. R. (1982). Hysteroid dysphoria. Am. J. Psychiatry, 139, 1520–1.
Klein, D. F., and Davis, J. M. (1969). Treatment of affective disorders. In Diagnosis and Drug Treatment of Psychiatric Disorders, D. F. Klein and J. M. Davis, eds, pp. 304–5. Baltimore, MD: Williams and Wilkins.
Koukopoulos, A. (1999). Agitated depression as a mixed state and the problem of melancholia. Psychiatr. Clin. North Am., 22, 547–64.
Koukopoulos, A., Faedda, G., Proietti, R. et al. (1992). Mixed depressive syndrome. Encephale, 18, 19–21.
Koukopoulos, A., Girardi, P., Proietti, R. et al. (1989). Diagnostic and therapeutic considerations on agitated depression understood as a mixed affective state. Minerva Psichiatr., 30, 283–6.
Koukopoulos, A., Pani, L., Serra, G. et al. (1995). Anxious-excited depression: a mixed affective syndrome. Encephale, 21, 33–6.
Kraepelin, E. (1883). Psychiatrie. Leipzig: JA Barth.
Kraepelin, E. (1887). Psychiatrie, 2nd edn. Leipzig: JA Barth.
Kraepelin, E. (1889). Psychiatrie, 3rd edn. Leipzig: JA Barth.
Kraepelin, E. (1893). Psychiatrie, 4th edn. Leipzig: JA Barth.
Kraepelin, E. (1896). Psychiatrie, 5th edn. Leipzig: JA Barth.
Kraepelin, E. (1899). Psychiatrie, 6th edn. Leipzig: JA Barth.
Kraepelin, E. (1904). Psychiatrie, 7th edn. Leipzig: JA Barth.
Kraepelin, E. (1913). Psychiatrie, 8th edn. Leipzig: JA Barth.
Kukopulos, A., Reginaldi, D., Laddomada, P. et al. (1980). Course of the manic-depressive cycle and changes caused by treatment. Pharmakopsychiatr. Neuropsychopharmakol., 13, 156–67.
Lange, J. (1928). Die endogenen und reaktiven Gemuetserkrankungen und die manische-depressive Konstitution. In Handbuch der Geisteskrankheiten, O. Bumke, ed., p. 111. Berlin: Verlag von Julius Springer.
Lewis, A. (1934). Melancholia: a clinical survey of depressive states. J. Mental Sci., 80, 277–378.
Liebowitz, M. R. and Klein, D. F. (1981). Interrelationship of hysteroid dysphoria and borderline personality disorder. Psychiatr. Clin. North Am., 4, 67–87.
Lorry, A. C. (1765). De Melancholia et Morbis Melancholicis. Paris: Lutetia Parisorium.
Marneros, A. (2001). Origin and development of concepts of bipolar mixed states. J. Affect. Disord., 67, 229–40.
McElroy, S. L. (1997). Detecting and treating the spectrum of mixed mania and depression. 150th Annual Meeting of the APA, San Diego, CA.
Mentzos, S. (1967). Mischzustaende und mischbildhafte phasische Psychosen. Stuttgart: Enke.
Meyer, A. (1951). The Collected Papers of Adolf Meyer. Baltimore, MD: Johns Hopkins Press.
Nelson, J. C., and Bowers, M. B. Jr. (1978). Delusional unipolar depression: description and drug response. Arch. Gen. Psychiatry, 35, 1321–8.
Parker, G. (2002). Olanzapine augmentation in the treatment of melancholia: the trajectory of improvement in rapid responders. Int. Clin. Psychopharmacol., 17, 87–9.
Parker, G. and Malhi G. (2001). Are atypical antipsychotic drugs also atypical antidepressants? Aust. N. Z. J. Psychiatry, 35, 631–8.
Perugi, G., Akiskal, H. S., Micheli, C. et al. (1997). Clinical subtypes of bipolar mixed states: validating a broader European definition in 143 cases. J. Affect. Disord., 43, 169–80.
Plato (1994). Republic. London: Harvard University Press.
Post, R. M., Rubinow, D. R., Unde, T. W. et al. (1989). Dysphoric mania. Clinical and biological correlates. Arch. Gen. Psychiatry, 46, 353–8.
Richarz, F. (1858). Ueber Wesen und Behandlung der Melancholie mit Aufregung (Melancholia agitans). Allg. Ztschr. Psychiatr., 15, 28–65.
Rush, B. (1830). Medical Inquiries and Observations upon the Diseases of the Mind. Philadelphia: John Grigg.
Schatzberg, A. F. (1998). Bipolar disorder: recent issues in diagnosis and classification. J. Clin. Psychiatry, 59 (suppl. 6), 5–10; discussion 11–12.
Schmidt-Degenhardt, M. (1983). Melancholie und Depression. Stuttgart: Kohlhammer.
Schneider, K. (1962). Klinische Psychopathologie. Stuttgart: Thieme Verlag.
Secunda, S. K., Swann, A., Katz, M. M. et al. (1987). Diagnosis and treatment of mixed mania. Am. J. Psychiatry, 144, 96–8.
Small, J. G. (1985). Efficacy of electroconvulsive therapy in schizophrenia, mania, and other disorders. II. Mania and other disorders. Convuls. Ther. 1, 271–6.
Specht, G. (1908). Ueber die Strukture und klinische Stellung der Melancholia agitata. Zentralbl. Nervenheilkr. Psych., 39, 449–69.
Spiker, D. G., Weiss, J. C., Dealy, R. S. et al. (1985). The pharmacological treatment of delusional depression. Am. J. Psychiatry, 142, 430–6.
Spitzer, R. L., Endicott, J., Robins, E. et al. (1978). Research Diagnostic Criteria (RDC). New York: Biometrics Research Evaluation Center, New York State Psychiatric Institute.
Stransky, E. (1911). Das manisch-depressive Irresein. Handbuch der Psychiatrie. Leipzig: Deuticke.
Swann, A. C., Secunda, S. K., Kalz, M. M. et al. (1993). Specificity of mixed affective states: clinical comparison of dysphoric mania and agitated depression. J. Affect. Disord., 28, 81–9.
Teicher, M. H., Glod, C., Cole, J. O. et al. (1990). Emergence of intense suicidal preoccupation during fluoxetine treatment. Am. J. Psychiatry, 147, 207–10.
Thalbitzer, S. (1908). Die manisch-depressive Psychose: das Stimmungs-irresein. Arch. Psychiatr. Nervenkr., 43, 1071–127.
Weitbrecht, H. J. (1963). Psychiatrie in Grundriss. Berlin: Springer.
Wernicke, C. (1906). Grundriss der Psychiatrie. Berlin: G. Thieme.
Westphal, A. and Koeplin O. (1907). Bemerkungen zu dem Aufsatze von Prof. Dr. G. Specht: ueber den Angstaffekt im manisch-depessiven Irresein. Zentralbl. Nervenheilkr. Psych., 18, 729–31.
Weygandt, W. (1899). Ueber die Mischzustaende des manisch-depressiven Irreseins. Munich: Lehmann.
World Health Organization (1992). ICD-10: International Statistical Classification of Diseases and Related Health Problems, 10th revision. Geneva: World Health Organization.
Ziehen, T. (1902). Psychiatrie. Leipzig: Hirzel.