Frequent Anger and Irritability Could Signal Depression

Did you know that getting angry or irritable on a regular basis is related to depression? 

Most of us get triggered – even if slightly – by petty things happening in our lives or the lives of others. Being mad at your cheating boyfriend is surely justified. However, a reaction with similar emotional intensity for not being able to get to work on time or for someone not answering the phone could qualify as petty. Isn’t that so?

Not many people understand that their episodes of irritability or anger are closely linked with depression.

According to The World Health Organization (WHO), depression is characterized by an absence of motivation, lack of interest and joy, low energy, anxiety, reduced appetite, bad sleep, no self-love, guilt for past mistakes, and surprisingly, symptoms that cannot be explained by medical experts yet. You may have noticed that anger is missing from this list…

As many years of research have shown, symptoms of depression can vary depending on its level of severity.

Unlike people going through mild depression, those with severe episodes are not likely to keep on being productive, sociable, or active in their own households.

It is worth noting that in the Diagnostic and Statistical Manual of Mental Disorders, which many people call the bible of psychiatry, anger is not listed as a core symptom for deep depression.

Attesting to this, Dr. Maurizio Fava, a psychiatrist at the Massachusetts General Hospital and a professor at Harvard Medical School said that anger is not part of the symptoms for depression in adults.

Interestingly, it is listed as a major symptom of depression in children adolescents. But why are adults missing here?

To some degree, this is explained by Renee D. Goodwin, who looked into association in youths between coping behavior when angered and depression. She discovered that coping behaviors such as drug abuse, aggressive behavior coping, and emotional coping when angered, increase the chance of deep depression. In addition, physical activity was linked to lower levels of depression. She added that what teens see as a coping mechanism for anger could in fact be linked to depression.

Her findings suggest that if the teen continues being aggressive or abuses substances even after 18 years of age, then anger episodes and, in turn, depression are highly likely. Even though there is not much data about this, it will be crucial for future research.

According to the WHO people who have depression accompanied by manic episodes, such as bipolar disorder, show irritable mood, pressure when speaking, overreaction, disturbed sleep, and inflated confidence.

Dr. Fava wonders why anger or irritability is not widely considered as part of depression with a balanced mood but depression with manic episodes. Why is it that a grown-up person with a ton of anger inside is categorized as bipolar or having a personality disorder?

About 20 years ago mental illness was considered a taboo topic in many parts of the world. Be it then or now, depression is mostly associated with being sad, lifeless, joyless, emotionally hurt but never or hardly in relation to feelings like anger. We blindly believe everything we read on medical websites and diagnostic manuals that are not including anger – a byproduct of depression.

Dr. Fava has tasked himself with observing patients in his clinic who have issues with anger but are categorized as having other diagnoses.

The reason behind this is that people think a person should not be angry if they are depressed. But if the diagnosis is wrong, how can someone receive the right treatment?

It is widely believed that depressed individuals are angry at themselves, but there are many who suffer from depression who have been found to act aggressively. They are later overcome with regret and guilt for their outbursts. This means anger can be expressed towards us and towards the people around us.

In his article ‘Anger attacks in patients with depression’, Fava talks about anger attacks resembling panic attacks except for the lack of predominant effects of anxiety and fear linked to panic attacks.

And according to his research piece ‘Depression with anger attacks’, this type of anger and aggressive behavior was lower in the 53% to 71% of depressed individuals treated with anti-depressants. It is important to note, however, that more studies in support of this still need to be carried out.

If one looks at the massive amount of information available on depression, anxiety, and mood disorders, it can easily be concluded that anger has been mostly neglected. Dr. Fava suggests that there is a need for looking into all the variables and all the kinds of patterns or levels of anger that human beings experience.

In a piece titled ‘Anger in the context of postnatal depression: An integrative review’, the data showed that anger is an overlooked aspect of depression even in post-natal depression.

Experts believe that the expression of maternal anger after child-birth is mostly unclear.

Data from a study titled ‘Depression is More Than Just Sadness: A Case of Excessive Anger and Its Management in Depression’, showed that there is data for therapeutic and pharmacological management for depression but it barely addresses symptoms of anger.

In a case study of a 27-year-old man who had moderate depressive experiences accompanied by bursts of anger, cognitive behavioral therapy was working well in both anger and depression management. However, such non-pharmacological treatments are not being used often when anger is linked to or worsened by depression.

Anger is not seen as being linked with depression by medical experts, because “The field has not sufficiently attended to problems with anger,” Dr. Mark Zimmerman, a professor of psychiatry at Brown University told NPR.

He stressed that there are different scales to consider if medications work for treating depression but do not include anger-specific items.

Also, he is of the mind that people who seek psychiatric help have increased anger but irritability is less frequent than anxiety and sadness.

In his survey of thousands of patients, Zimmerman and his co-workers asked people whether they felt or showed anger (and to what extent) in the week before. Half of them reported moderate or high levels of anger, while two-thirds reported notable anger and irritability.

In another big research of 500 subjects carried out by another team, 54% showed “overt irritability/anger,” during unipolar major depressive episodes, which is linked to major chronic depression. 

All in all, it is safe to say that if you find yourself getting angry or irritable on a regular basis, you may be depressed.

What are your thoughts on these findings? Let us know by joining the conversation in the comments and please share if you’ve found this article helpful.

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