Sally, a friend of mine, called me and asked if the two of us could get together for a sit-down. After some brief chitchat, she told me that recently she had gone through a period of being quick to anger about “every little thing,” as she put it. She went on to say, “Joe, I had no idea this was linked to my mental health. I decided to see a therapist and she explained that anger and irritability are related to depression. I did not think that anger aligned with being depressed.” I told Sally she had made a wise choice to begin working with a therapist, and I confirmed that anger manifestations – particularly about trivial or inconsequential issues – can be symptomatic of depression.
Sally is far from alone. I certainly have been referred depressed clients coming from other therapists and even physicians who reported that they had never been asked about anger or persistent bouts of irritability.
Peruse the DSM-5 criteria for depression for a moment or two, and you’ll notice that the list of core symptoms in the adult classification of depression does not include anger. But interestingly, irritability, which often results in angry reactions, is listed as a core symptom of depression in children and adolescents – begging the question, “why would irritability and anger as a depressed adolescent no longer be an issue once the individual turns age 18?
Anger is both emotional and physical, leading angry people to issue warnings and also intimidate and attack those whom they perceive as threatening. Depressed, angry adults are often pigeonholed into diagnoses consistent with “upset” of some sort, such as bipolar disorder or certain personality disorders. But although psychiatry has sufficiently studied how anxiety and depressed mood are intertwined, anger has been mostly neglected or overlooked.
Many of us counselors and therapists came up in the ranks being taught that with depression, anger is turned inward – that is, depressed people project the anger or irritability onto themselves and not others. But this is not the case in as many as 30 percent of depressed patients, leading to an alternative conclusion: Much of anger is “self-anger,” but is redirected outwards to preserve one’s sense of worth. I recognize this in my own practice and now routinely ask depressed clients if they ever lose their temper and have outbursts resulting in yelling or screaming at others. If they answer yes, I’ll include anger management and de-escalation strategies into our treatment plan.
Unresolved, traumatic events dating back to childhood and continuing into adulthood are often responsible for depression and accompanying anger. Thus trauma serves as a catalyst for acting out at loved ones or close friends who have nothing to do with the actual cause of the anger. Screening depressed patients and asking about symptoms or behaviors such as picking fights, persistent irritability, being critical, mean, or sarcastically putting others down can help them better understand that these are obviously unproductive ways for handling problems.
Depressed people can have a hard time recognizing such factors without assistance from a supportive mental health professional who fully understands anger dynamics and their ramifications.
Attribution Statement:
Joe Wegmann is a licensed pharmacist & clinical social worker has presented psychopharmacology seminars to over 10,000 healthcare professionals in 46 states, and maintains an active psychotherapy practice specializing in the treatment of depression and anxiety. He is the author of Psychopharmacology: Straight Talk on Mental Health Medications, published by PESI, Inc.
To learn more about Joe’s programs, visit the Programs section of this website or contribute a question for Joe to answer in a future article: joe@thepharmatherapist.com.