Our standard understanding of depression is that it results in feelings of hopelessness or sadness, often associated with a lack of motivation or concentration. In most cases, we consider these “low energy” feelings; and, if you notice, “irritability” and “anger” are not among them. Apparently there is a common belief about depression that does not associate with these “high energy” feelings.
And, apparently, that belief is a common misconception. Indeed, Massachusetts General Hospital psychiatrist Dr. Maurizio Fava advises “It’s not included at all in the adult classification of depression.”
As a matter of fact, irritability—a reduced control of temper that typically results in anger—is listed as a main symptom of depression in both children and adolescents but not in adults. And this, Fava says, has never made sense to him.
Also an Harvard Medical School professor, Fava goes on to say, “We see in our clinics patients who are labeled as having other diagnoses because people think, ‘Well, you shouldn’t be so angry if you are depressed’.”
But the diagnosis is important because its accuracy affects the type of treatment that might be recommended. For example, several decades ago, the standing belief was that anger projects inward in depression. Fava says that this is very different than what he is seeing today. In fact, anger is both emotional and physical and, when outwardly projected, is generally assumed to be a symptom of bipolar or personality disorder than of clinical depression.
Fava adds, “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.” And then after this behavior—and perhaps the thing that is most telling—they would experience great remorse.
Observing and analyzing this, then, Fava now believes that these anger attacks could be a phenomenon that is similar to panic attacks. He says that his research suggest this kind of anger will subside in most of these patients with the simple addition of antidepressants.
Psychiatrists have thoroughly studies how different patients experience and manifest anxiety and depression. Anger, though, is often overlooked even though it is generally the way doctors determine if treatments are working: if you take antidepressants or go to therapy are they resulting in better moods or are you still irritable?
All in all, then, scientists now say that including anger in depression therapy should provide more diverse treatment so more patients can find success.