agitated depression

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VM1-4BT7JCG-4&_user=915767&_coverDate=04%2F30%2F2004&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=1331482145&_rerunOrigin=scholar.google&_acct=C000047922&_version=1&_urlVersion=0&_userid=915767&md5=02921e7b319ac5ff68395f33c25dc103

"Mixed depression was operationally defined by the coexistence of a MDE and at least two of the following excitatory signs and symptoms: inner psychic tension (irritability), psychomotor agitation, and racing/crowded thoughts.

MDE plus psychic tension (irritability) and agitation accounted for 15.4%, and MDE plus agitation and crowded thoughts for 15.1%. The highest rate of mixed depression (38.6%) was achieved with a definition combining MDE with psychic tension (irritability) and crowded thoughts: 23.0% of these belonged to MDD and 76.9% to BP-II. Moreover, any of these permutations of signs and symptoms defining mixed depression was significantly and strongly associated with external validators for bipolarity. The mixed irritable-agitated syndrome depression with racing-crowded thoughts was further characterized by distractibility (74–82%) and increased talkativeness (25–42%); of expansive behaviors from the criteria B list for hypomania, only risk taking occurred with some frequency (15–17%).

These findings support the inclusion of outpatient-agitated depressions within the bipolar spectrum. Agitated depression is validated herein as a dysphorically excited form of melancholia, which should tip clinicians to think of such a patient belonging to or arising from a bipolar substrate. Our data support the Kraepelinian position on this matter, but regrettably this is contrary to current ICD-10 and DSM-IV conventions. Cross-sectional symptomatologic hints to bipolarity in this mixed/agitated depressive syndrome are virtually absent in that such patients do not appear to display the typical euphoric/expansive characteristics of hypomania—even though history of such behavior may be elicited by skillful interviewing for BP-II. We submit that the application of this diagnostic entity in outpatient practice would be of considerable clinical value, given the frequency with which these patients are encountered in such practice and the extent to which their misdiagnosis as unipolar MDD could lead to antidepressant monotherapy, thereby aggravating it in the absence of more appropriate treatment with mood stabilizers and/or atypical antipsychotics."

the spectrum of polar bears

:) :) :) this is not how happy I feel, but maybe looking at the smiley icons can calm me down a little. Like the theory that smiling can actually make you feel happier.

I should probably start tracking my moods. Maybe I can use white polar bears and black polar bears. Today I'd give myself one black polar bear. Maybe two. I don't want to kill myself today. I'm thinking about the future, even if apprehensively so. It's more the anxiety getting me down today, so maybe I should use separate scales for depression, elation and anxiety. I could throw in another one for suicidality. Agitation vs retardation. Sleep time and quality. Alcohol, caffeine cigarettes. I could record my entire life. I'm an all-or-nothing person, and the all seems too extreme, too much to go through every single day. I need to find an easy way to record the important things. I don't do well with number scales. How do you choose a number? Choosing is even harder when depressed! I can spend hours trying to decide whether or not I'm going to buy a newspaper that costs a dollar, so how can I choose between 3, 5, or even 10 numbers? A graphic or verbal representation might work better. A verbal scale could be something like: crappy, double crappy, death wish. The polar bears thing could be the graphic representation of my mood. Either way, I'm using a 3-point scale which can be conveniently converted to a number.

So, today I feel crappy. But this morning I felt fine. Ish. Fine-ish. Verbal scale for elation: fine-ish, fine, happy. I don't know if I ever get past "happy", but I do get overexcited, sometimes restless. Let's call fine-ish the midline of my mood range, neither depressed nor elated. The elation scale can then be fine, happy, awesome.

So, when I woke up at 11am I was fine-ish, now, at 3pm I feel crappy.

Anxious, double anxious, or freaking out? I'd say anxious. Just a feeling floating around my mind that I have things to worry about.

Agitation? yes (in the form of jiggling feet and legs, nail biting). Tired? yes. Mentally or physically slowed? no.

Sleep? 10 hours or so. I didn't have too much trouble falling or staying asleep.

There! I did it. I recorded the important information about my mood state today.