Anger and irritability are two symptoms of depression that we don’t talk about nearly enough
When we think about depression, we often picture someone curled up in bed, crying, and silence. But although that’s now depression looks for some people, psychologists want you to know that it can look different for everyone. Specifically, some people with depression, especially chronic or severe depression, report feeling angry and irritable.
This week at NPR, Nell Greenfieldboyce of Morning Edition talked about this hugely overlooked symptom of depression with two experts: Dr. Mark Zimmerman, a professor of psychiatry at Brown University, and Dr. Maurizio Fava, a psychiatrist at Massachusetts General Hospital and a professor at Harvard Medical School.
The consensus? People need to realize that anger and irritability often go hand in hand with depression, and that medical professionals need to take that into consideration both when diagnosing and treating patients struggling with their mental health.
“The field has not sufficiently attended to problems with anger,” Zimmerman told NPR. “Irritability is not that much less frequent than sadness and anxiety in patients who are presenting for psychiatric treatment.”
“I would say 1 in 3 patients would report to me that they would lose their temper, they would get angry, they would throw things or yell and scream or slam the door,” Fava said of his experience treating anger in depressed patients.
He also says that these “anger attacks” are similar to what panic attacks are in patients with anxiety.
— Megan Simpson, HBHSc, MA (@meganksimpson) January 30, 2019
Shockingly, right now the Diagnostic and Statistical Manual of Mental Disorders, which is basically the Bible of mental conditions only lists anger and irritability as main symptoms of depression in adolescents and not of depression in adults. But studies tell a much different story.
In a 2013 study published in JAMA Psychiatry, more than half of 500 people with major depression reported feeling angry and irritable.
In a 2017 survey, Zimmerman and his colleagues found that of 3,800 new outpatients at Rhode Island Hospital’s psychiatric branch, two out of three reported anger. Of those, half that had signs of overt anger were diagnosed with severe depression.
Why are depression and anger linked? Researchers are still trying to find out. Part of depression involves angry feeling being turned inward, to beat yourself up – some believe that some sufferers might also turn anger outward, too.
The lack of information about the link between anger and depression is likely stopping many people from getting the help that they need.
Christal Yuen wrote about her own experience for Healthline, in which it took her months to figure out her anger was being caused by depression.
“I always figured that if I was angry, I couldn’t be depressed,” she wrote. “Knowledge is not a treatment but it sure helps give control, and understanding how things work is a strong defuse. Now that I know anger is a product of my depression, I might be able to start tracking my moods more accurately. Now that I can share this story, those who care about me might also be able to call out the signs for me. Now that I understand how my depression works for me, I can help myself.”
It’s a theme that both the experts and depression patients with anger can agree on: understanding that anger and depression are linked can help everyone fight the disease, from diagnosing it, to naming it during an outburst, to talking about it in therapy, to realizing that it’s not your fault.