It can be hard for parents to distinguish whether their child’s outburst is typical teenage anger, fueled by hormones and growing pains, or a symptom of something more serious, such as depression. Many parents and even some primary care physicians typically associate depression with feelings of hopelessness, sadness and a lack of motivation or concentration, but not immediately with feelings anger. Given that mental health research now indicates there is a strong link between irritability and depression, this is an important connection that is often not happening.
While fatigue and melancholy are readily associated with depression, anger is often an overlooked symptom. In the Diagnostic and Statistical Manual of Mental Disorders (DSM), a resource used to diagnose mental health issues, anger is listed as a symptom of depression for children and teens. Dr. Maurizio Fava, who practices at Massachusetts General Hospital and teaches at Harvard Medical school, states that 1 in 3 of his patients shared that they’ve experienced angry outbursts associated with depression.Fava calls the outbursts anger attacks. “They would lose their temper, they would get angry, they would throw things or yell and scream or slam the door,” says Fava. Afterward, they would be filled with remorse. Fava believes these anger attacks appear to be similar to panic attacks. His research found that they subsided in most patients treated with antidepressants.
Fava says that when he was initially trained in psychiatry, it was thought that with depression, anger was projected inward. In other words, depressed people would be angry with themselves but not with others. Yet, Fava discovered that wasn’t what he was actually experiencing with many of his patients with depression. He believes that while psychiatry has carefully studied how anxiety and depressed moods are experienced by patients, anger has been relatively neglected. Fava would like to see the medical community study anger more closely, believing it could lead to a greater understanding of depression. “I don’t think that we have really examined all the variables and all the levels of anger dysregulation that people experience,” he says.
Dr. Mark Zimmerman, professor of psychiatry at Brown University, agrees with Fava. “The field has not sufficiently attended to problems with anger. The most frequently used scales to evaluate whether medications work for treating depression don’t have any anger-specific items,” he says. Given that anger associated with mental illness, specifically depression, hasn’t been studied, it makes it difficult to know what treatment might work to alleviate this symptom.
Zimmerman says clinicians frequently see increased anger in people seeking help for depression. “Irritability is not that much less frequent than sadness and anxiety in patients who are presenting for psychiatric treatment,” he says. Zimmerman and colleagues recently surveyed thousands of patients making their first visit to the Rhode Island Hospital’s outpatient psychiatric practice. All were asked about the level of anger they had felt or expressed in the preceding week. Zimmerman says “…two-thirds of individuals reported notable irritability and anger and approximately half reported it at a moderate or severe level.”
Another large study that looked at more than 500 people who had been diagnosed with major depression found that more than half showed “overt irritability/anger,” and, that this anger and irritability appeared to be associated with more severe, chronic depression.
Still, people with depression can have a hard time recognizing it in their own lives. Kevin Einbinder, who oversees communications for the Depression and Bipolar Support Alliance, said that in looking back over his own life, he could see that anger had played a major role in many of his relationships, although he hadn’t realized it until a journalist posed the question. He says he initially thought, “I’m sure somebody else certainly deals with anger, but I don’t have anger issues associated with depression.” Then he noted, “…I thought of all the people in my life who have interacted with me—my family, the counselors, psychiatrists, even employers, significant others–and I realized that anger was an underlying factor in all those relationships.” Einbinder says he wishes he’d been aware of it, or that his care providers had known to ask about anger. “I think that would have provided a tremendous amount of context for what’s adding to my depression and in helping me, early on in my life, with more effective coping mechanisms.”
With medication and therapy, Einbinder is doing much better today and hopes that sharing his experiences will help people understand that if they’re dealing with depression and anger, “they’re not alone and there’s loads of resources out there.”
Symptoms of anger and depression
Anger is a feeling that often goes away after a short period of time. Symptoms include:
- rapid heartbeat
- increased blood pressure
- rage
- aggressive behavior
Depression is a consistent feeling of deep sadness or hopelessness that lasts for weeks or longer. Symptoms of depression may include:
- anger
- feelings of confusion, sadness, or hopelessness
- extreme weight loss or weight gain
- loss of interest in things you normally enjoy
- loss of energy
- unexplained body aches and pains (that is, they aren’t because of an accident or exercise)
- thoughts of harming yourself or ending your life
Getting help
If you are concerned about your child’s mental health, So Cal Adolescent Wellness is available to provide support for your family. We are an after school, early intervention, teen program located in Orange County. We would be happy to verify your insurance benefits and schedule a free confidential Assessment with our specially trained Adolescent Treatment Team. We can be contacted by telephone at 714-465-5583 or at info@socaladolescentwellness.com
