Unusual forms of depression sometimes occur in the elderly. Increased activity, relentless pacing, incessant hand wringing can all point to a picture of agitated depression. This particular presentation is difficult for relatives and companions (usually equally of an elder age) of the depressed person and insomnia should also be assessed in their own right. The spouse will often be found to be exhausted and suffering from some aspects of depression also. The management of the elderly agitated depressed patient (and indeed other symptoms of depression) will include consideration of measures designed to support the companion or relatives such as day respite care.