DR BLACK: Dr Nasrallah, I think you may have taught me that agitated depression
in the late teens can often herald the onset of bipolar disorder.
An agitated depression
with components of inappropriate anger, anxiety, and disinhibition are associated with right hemisphere injuries.
The Research Diagnostic Criteria (a forerunner in the 1970s to DSM-III) described agitated depression
, but the disorder was not included in any DSM editions--although it is a "clinical modification" for MDD in the 10th revision of the International Statistical Classification of Diseases and Related Health Problems.
This includes the use of sedative medications for the treatment of anxiety, agitated depression
, insomnia, or related disorders.
If bipolar disorder is misdiagnosed as agitated depression
, the symptoms might worsen and antidepressant use could precipitate rapid cycling or a switch to mania.