Melancholia agitata and mixed depression

Acta Psychiatr Scand Suppl. 2007;(433):50-7. doi: 10.1111/j.1600-0447.2007.00963.x.


Objective: The diagnostic entity of major depressive episode includes both simple and agitated or mixed depression. Mixed depression is characterized by a full depressive episode with several symptoms of excitatory nature. Mixed depressions worsen if treated with antidepressants.

Method: We have reviewed the clinical charts of the 2141 patients treated at the Centro Lucio Bini of Rome from January 1999 to June 2006. These patients were diagnosed according to DSM-IV criteria. Research diagnostic criteria were applied for agitated depression with motor agitation and Author's diagnostic criteria for agitated depression without motor agitation.

Results: One thousand and twenty-six patients had a depressive episode as index episode. Three hundred and forty six (33%) were mixed depressive states. One hundred and thirty eight (44%) of them were spontaneous; in 173 cases, the onset of the mixed depression was associated with antidepressants.

Conclusion: Psychic and motor agitation are considered equally important for the definition of agitated depression. Treating agitated depression with antidepressants worsens the clinical picture. The use of Electroconvulsive Therapy (ECT), neuroleptics and anticonvulsants are recommended. The term Melancholia Agitata is proposed for agitated (mixed) depression.

MeSH terms

  • Adult
  • Antidepressive Agents / adverse effects
  • Depressive Disorder / diagnosis*
  • Depressive Disorder / drug therapy
  • Depressive Disorder / epidemiology*
  • Depressive Disorder, Major / diagnosis*
  • Depressive Disorder, Major / drug therapy
  • Diagnosis, Differential
  • Diagnostic and Statistical Manual of Mental Disorders
  • Female
  • Humans
  • Male
  • Prevalence
  • Psychomotor Agitation / diagnosis
  • Psychomotor Agitation / drug therapy
  • Psychomotor Agitation / epidemiology*
  • Terminology as Topic


  • Antidepressive Agents