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Agitation - however, it's complicated
Posted: Tuesday, September 1, 2015 7:48 PM
Joined: 5/10/2015
Posts: 29

Hello, I did a search on this topic and didn't really find anything specific.

I have early onset Alzheimer's (EO AD) diagnosed via PET scan. However, I was previously diagnosed bipolar about 12 years prior to the Alzheimer's diagnosis. I take lithium and Aricept and Ambien for sleep.

In June, my psychiatrist diagnosed me as having agitated depression, which actually feels correct. He has prescribed Cymbalta 20 mg. I was afraid I was going to be pulled over by the police for the yelling I was doing. I don't think the Cymbalta has totally solved the problem and I'm wondering if this is Alzheimer agitation. I see my psychiatrist Monday and I am to see a new neurologist at the end of September.

I don't know if it is the hot weather or what, but I am definitely having agitation and some fluctuation in my moods. I went to see my old neurologist in June. I had to drive like three hours and had a meltdown when I got there and would not proceed with the testing. I also had an unbelievable blow-up with my best friend when it was this hot LAST YEAR!

Any comments would be greatly appreciated. Apparently 5% of the population have early onset Alzheimer's, and 5% of the EOAD population have bipolar as well.

Thanks, AnDi

Iris L.
Posted: Tuesday, September 1, 2015 8:36 PM
Joined: 12/15/2011
Posts: 16579

An Di, the symptoms of dementia and depression overlap to quite a great degree. Only an expert can determine the difference, and it will take some time to be sure. My own dx includes cognitive impairment nos along with major depression. I have had extensive testing. My neurologist is still not exactly sure of my dx, and I have been with him for over six years.

If you are still having significant behavioral impact, you need to work closely with the psychiatrist. Some psychiatrists only prescribe medications, and refer the patient to a psychologist for psychotherapy. If there is a history of bipolar depression, you need both.

Other supportive services for a person with a significant mental health history are also necessary, such as a support group or day program.

Also, know that sometimes sedatives, such as Ambien, can have a paradoxical effect, and actually make the patient more agitated instead of sedated. This effect may happen after taking the Ambien for some time.

You need to consciously develop stress reduction techniques for your daily life.

A surprising note about bipolar disease, is that very often patients become manic at this time of the year, at the autumnal equinox (autumn). I know it is not exactly autumn yet, but my point is that there may be a seasonal reason for your agitation. Are you becoming manic? Can you tell? You need someone to help you.

Please keep us updated on how you are doing.

Iris L.

Posted: Tuesday, September 1, 2015 9:19 PM
Joined: 10/11/2014
Posts: 167

Hi An Di,
Many ALZ patients gets misdiagnosed as just depression and after they get a devastating diagnosis of ALZ then many people would get depressed. My findings and opinion is that most of all our problems stems from mercury poisoning from "amalgam" "silver fillings which are actually 50 percent mercury. These mercury fillings causes ALZ, MS, ALS, lupus, cardiovascular disease and bipolar disorder.

I will have to add these links to my blog.

Posted: Tuesday, September 1, 2015 11:46 PM
Joined: 11/27/2014
Posts: 88

I never knew the statistics for bipolar and EOAD. I was diagnosed with BiPolar 9 years ago. Medication Is the only way I can cope. I need to have bipolar controlled to deal with EOAD. You are lucky that that is all the meds you have to take.
Posted: Wednesday, September 2, 2015 8:13 AM
Joined: 5/20/2014
Posts: 4405

I get easily agitated these day's and now have started cursing at work! It's embarrassing and sometimes I wonder if it's because I cannot find other words emphatic enough to stress importance. Need to find replacement words and stop doing this!
Jo C.
Posted: Wednesday, September 2, 2015 12:18 PM
Joined: 12/9/2011
Posts: 11158

Hello An DI; I am very sorry for what you are experiencing and can imagine how difficult this is for you.

Agitated depression and fluctuation of moods are both very common in bipolar disorder. It is not an oridinary sort of depression most people would talk about who do not have bipolar disorder; it is different.

The agitated depression comes out as severe anger for many folks in this situation. The cycling of moods are also very much part and parcel of the bipolar disorder dynamics.

See your psychiatrist as you are planning to do and having him adjust your medication is a perfect plan. It would then be good to followup closely with him or her to ensure that you are getting best results.

I send you best wishes and hope your appointment brings success,


Posted: Wednesday, September 2, 2015 12:21 PM
Joined: 9/12/2013
Posts: 3560


I am agitation central.

I think there are certain outside conditions that set us off as we are learning how to live in the world with dementia. Not just some screwy thing with our brain neuro chemistry.

I was diagnosed bi-polar after I got married at mid life. Looking back I see the subtle knowledge of being less capable was setting off a lot of anxiety. The chemicals of anxiety and stress are toxins when prolonged in an inhospitable environment.

My agitation theory is we are on a learning curve that is constantly changing, how to negotiate life with a changing brain. Once I figured that out I started to name the things that overloaded my abilities to cope.

Also psychiatrist I had seen for 8 years told me no more meds for bi-polar, and changed me to Zoloft micro dose, as many anti depressants aggravate dementia. I do cycle in moods, but in friendly living conditions the highs were productive and happy, the lows were kind of poetic and generated compassion.

I have not seen psychiatrist in 3 years and am usually doing pretty good. Right now I am pushing myself through home repairs so I can sell house and be away from husband, who I now see as not helpful in any way except for a ride to church on Sunday. He is toxic to me. Since one can not get a divorce with dementia unless a conservator is appointed, I figure changing my will is a good idea asap. (this is no snap decision or demented idea - should have left day after wedding ceremony).

We all need recovery time from being in the world. Breathing space. Quiet. Lower the input visual and auditory. I think if we all had a small safe room, a sanctuary, it would be super helpful to recovering stability.

driving in traffic, other people in your space, pressure to keep appointments, often phone calls are unnerving, figuring out how to pay bills, did we take a med? how does a washing machine work again? repair sounds on streets or in home...on and on the list goes of what we each find a challenge, a drain.

I took an upstairs bedroom for myself a few years before I was diagnosed. Only dog is welcome in there. it helps. I did not realize how crucial that was until lately! Husband was glad to have me gone, too.

Big agitation is very common, very disturbing, and sometimes it has gotten hold of me until I went into a meltdown. Talk about hell, to be upset and not able to end it or to start yelling in public, looking crazy. If there is not someone with the calm force to break through it can be dangerous. Yes, take it seriously but don't be afraid of it, learn what slows, stops it.

You are absolutely right that this is part of dementia. How you set up your life, the new rules you make to avoid stressed out agitation, are the best treatments.

I am not the only one who has found medical marijuana to be helpful big time, but it is a personal choice and may not be good for others. Aromatherapy is instant and powerful. Dog or horse presence also huge help to stability. My time in woods is essential to feeling better, probably lots of pine and fir essence in air and bird calls will change my focus back to here and now.

Something funny can shift chemistry instantly.

Also the Value of a physically feeling feelings often is avoided. the medicinal value of weeping aloud over all the fear, anger and worry, losses to come and the whole ball of wax should be honored. Once they get their due respect and expression, they pass. Courage comes in again.

We feel nervous when we do not feel safe, or feel unwanted, or in over our heads. Maybe everyone does, but dementia heightens it 200%.

All the best and lots of love. Thanks for bringing this up! You are doing really well, you're helping us all think about this murky stuff.

Posted: Thursday, September 3, 2015 9:04 PM
Joined: 5/10/2015
Posts: 29

I kind of forgot I posted this. Thank you everybody for your thoughtful replies. Got some other minor health things going on.

When first diagnosed, I did a lot of research on the agitated depression. The most helpful information I found was the following: The cardinal symptom of agitated depression is psychic agitation with or without motor agitation, and this agitation torments the patient and inhibits every activity and every pleasure. Even the racing thoughts are very different from the manic flight of ideas, which is expressed in speech. Racing thoughts of agitated depression are not verbalized and are very tormenting. Bipolar Disorders: Mixed States, Rapid Cycling and Atypical Forms A Marneros, F Goodwin

BOY, I have a lot of trouble with this website!!!! For the record, I do not know how to make connections or respond to people's requests to talk.

For the record, I don't think I have any more metal fillings because I have all crowns or caps. It sounds like someone has gone through a terrible experience however.

I certainly feel for all my brothers and sisters out there who are struggling, some of you for many years. There is a reason you are still around, even if it is just to help me. I appreciate it and God bless us every one!!!

Iris L.
Posted: Thursday, September 3, 2015 10:53 PM
Joined: 12/15/2011
Posts: 16579

An Di, some members do communicate privately via email through their Connections, but most of us focus on using the message boards to communicate.

Thanks for sharing the info about agitated depression.
I experienced racing thoughts for several years in the early years of my illness, but no one ever explained it the way you have, in over 28 years. You have solved a mystery for me!

Several members over the years have noted being suddenly diagnosed as being bipolar, then after a few years a dx of Alzheimer's disease was given.

It would be interesting to determine how many patients are newly diagnosed with psychiatric illness shortly before exhibiting significant memory loss.

In other words, how often is an agitated mood disorder the prodrome (early symptom) of a cognitive disorder?

I will bring this to my neurologist when I visit him at my next appointment.

Iris L.

Posted: Friday, September 4, 2015 7:04 PM
Joined: 7/24/2015
Posts: 3020

Hi AnDi, and welcome,

I am sorry that you are having these struggles. I know Cymbalta causes antsy-ness and agitation if the dose is too high. So I would not rule that out as the wrong med or at least as being too high.

Aricept also causes restlessness especially at night. So double whammy.

You know you better than anyone. I would just add a word of support in that being dx'd with dementia (and bi-polar) is cause for some serious personal grieving.

All that said, agitation is a serious aspect of Alz and dementia. I get very agitated at times. I have come to find, however, there is generally a root cause for it. Like, maybe I am too hot or too cold. The TV being on, even quietly in the background, often is just enough extra stimuli to feel like fingernails on a chalkboard.

No one seems to realize just how quiet, calm, and uncluttered we really need things to be. Not too many things, not too much noise, not too much patterns.

Wish you weren't facing all this. And wish I had more to offer. Hang in there.