An Uncommon Case of Major Depressive Disorder with Hyperactivity and Aggression in an Elderly Patient

Abstract

Major Depressive Disorder (MDD) is a common psychiatric condition in elderly populations, but its presentation can often be
atypical and more complex compared to younger individuals. Typically characterized by symptoms such as sadness, hopelessness,
and social withdrawal, MDD in older adults may present with unusual features like hyperactivity and aggression, which can
complicate diagnosis and treatment. This case report describes an 80-year-old male who presented with a three-week history
of escalating agitation, hyperactivity, and unprovoked aggression towards family members and caregivers. Despite the absence
of classical depressive symptoms such as persistent sadness, the patient exhibited irritability, impulsivity, and restlessness,
which raised suspicion for a mood disorder. A thorough clinical assessment, including a Mini-Mental State Examination (MMSE),
indicated mild cognitive impairment (MCI), and neuroimaging revealed no significant structural changes. After ruling out other
causes, a diagnosis of Major Depressive Disorder with Atypical Features, characterized by hyperactivity and aggression, was
made. The patient was treated with Escitalopram (an SSRI) and Olanzapine (an atypical antipsychotic), which led to a gradual
reduction in hyperactivity and aggression. This case highlights the importance of recognizing atypical presentations of MDD in
the elderly, where aggression and psychomotor agitation may overshadow the typical depressive symptoms. Early recognition
and tailored treatment approaches are crucial in managing such cases, ensuring better clinical outcomes and quality of life for
elderly patients. Further research is needed to explore these atypical presentations in depth.