Activated Depression: Mixed Bipolar Disorder or Agitated Unipolar Depression?

@article{Swann2013ActivatedDM,
  title={Activated Depression: Mixed Bipolar Disorder or Agitated Unipolar Depression?},
  author={Alan C. Swann},
  journal={Current Psychiatry Reports},
  year={2013},
  volume={15},
  pages={1-8}
}
  • A. Swann
  • Published 24 July 2013
  • Psychology
  • Current Psychiatry Reports
The combination of depression and activation presents clinical and diagnostic challenges. It can occur, in either bipolar disorder or major depressive disorder, as increased agitation as a dimension of depression. What is called agitation can consist of expressions of painful inner tension or as disinhibited goal-directed behavior and thought. In bipolar disorder, elements of depression can be combined with those of mania. In this case, the agitation, in addition to increased motor activity and… 
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References

SHOWING 1-10 OF 70 REFERENCES
Manic symptoms during depressive episodes in 1,380 patients with bipolar disorder: findings from the STEP-BD.
TLDR
Manic symptoms often accompany bipolar depressive episodes but may easily be overlooked when they appear less prominent than depressive features, and merit recognition as a distinct nosologic entity.
Does psychomotor agitation in major depressive episodes indicate bipolarity?
TLDR
Combined agitated and retarded major depressive states are more often bipolar than unipolar, but, in general, agitated depression ( with or without retardation) is not more frequently bipolar than retarded depression (with or without agitation), and pure agitated depression is even much less frequentlyipolar than un bipolar.
Manic symptoms and impulsivity during bipolar depressive episodes.
TLDR
Even modest manic symptoms during bipolar depressive episodes were associated with greater impulsivity, and with histories of alcohol abuse and suicide attempts, suggesting the presence of a potentially dangerous combination of depression and impulsivity.
Retrospective analysis of psychomotor agitation, hypomanic symptoms, and suicidal ideation in unipolar depression
TLDR
Although the bipolar nature of MDD–AD by common validators is failed to support, the association of agitation with hypomanic symptoms and suicidal thoughts in major depression is confirmed, and the complex phenomenology of AD in an inpatient setting is emphasized.
Agitated depression: a valid depression subtype?
  • F. Benazzi
  • Psychology, Medicine
    Progress in Neuro-Psychopharmacology and Biological Psychiatry
  • 2004
Agitated depression in bipolar II disorder
  • F. Benazzi
  • Psychology
    The world journal of biological psychiatry : the official journal of the World Federation of Societies of Biological Psychiatry
  • 2005
TLDR
Findings may partly support subtyping of AD in BP- II, on the basis of its frequent clustering of hypomanic symptoms, and its different family history, which may impact on treatment of BP-II depression.
Specificity of mixed affective states: clinical comparison of dysphoric mania and agitated depression.
A continuity between bipolar II depression and major depressive disorder?
  • F. Benazzi
  • Psychology
    Progress in Neuro-Psychopharmacology and Biological Psychiatry
  • 2006
Unipolar depression with racing thoughts: A bipolar spectrum disorder?
  • F. Benazzi
  • Psychology
    Psychiatry and clinical neurosciences
  • 2005
TLDR
MDD with racing/crowded thoughts seemed to be a severe variant of MDD, and had significant differences on bipolar validators, suggesting that it may lie along a continuum linking MDD without racing/ c Crowded thoughts and BP‐II.
...
...