Anger, irritability, and frustration may not be the core symptoms of major depression in adults, but almost 50% of people with major depression experience these symptoms (Fava et al., 2010; Judd et al., 2013). In addition, irritability may be the main presentation of mood in children and adolescents with depression. Having irritability and anger while being depressed is a double whammy. Overt irritability and anger during an episode of major depression is associated with greater severity of depression, longer duration of the episode of depression, poorer impulse control, a more chronic and severe long-term course of depression, higher rates of lifetime substance use and anxiety disorder, and greater psychosocial impairment (Judd et al., 2013).
When feeling depressed, you may be masking your more vulnerable feelings of hurt, guilt, shame, grief, or fear with anger or irritability. Depression causes the emotions that make you feel more vulnerable not come to the surface as you are uncertain on how to express them without feeling worse. However, it is important to focus on these hurtful emotions as anger may be manifesting as a secondary emotion because other primary emotions have not found expression. Underlying these hurtful emotions are irrational thoughts that can be challenged and replaced with more rational thoughts. For example, a person loses a parent, but due to life circumstance such as birth of a child, his normal grieving process is interrupted. A few months down the road, he starts getting irritable and snappy with his family and coworkers, feels tired most of the time, experiences insomnia, doesn’t enjoy pleasurable things as he used to, and is losing weight. It is likely that in this situation, the unresolved feelings of guilt related to interrupted grief are manifesting as depression, which is now presenting with irritability and anger. Thus, if this person were to focus only on ways to manage anger, it would only serve as a Band-Aid, while the deeper emotional problems related to guilt and grief would remain unaddressed. Therefore, when you are feeling depressed and also experiencing anger, ask yourself the following questions:
“If my anger were to talk to me, what would it tell me about my deeper feelings?”
“In what way does this situation hurt me?”
“Am I using anger to protect myself from other more vulnerable emotions?”
“Is there an underlying fear that is driving my anger?”
“Is there something I feel guilty or ashamed about this situation that is making me angry?”
Once you have identified the true emotions underlying your anger, then try to identify any fixed beliefs or assumptions associated with these emotions that you may be harboring. In the previous example, the person may be harboring the belief that he hasn’t been a good son to his parents, although there may not be any evidence to support that belief. Thus, identifying and challenging the irrational thoughts associated with the real feelings of hurt and not the proxy feelings of anger will pave the way for reducing both anger and depression.
Adapted from the comprehensive evidence-based book on depression The Complete Guide to Self-Management of Depression: Practical and Proven Methods.
Fava, M., Hwang, I, Rush, A. J., Sampson, N., Walters, E. E., & Kessler, R. C. (2010). The importance of irritability as a symptom of major depressive disorder: results from the national comorbidity survey replication. Molecular Psychiatry, 15(8), 856-867.
Judd, L. L., Schettler, P. J., Coryell, W., Akiskal, H. S., & Fiedorowicz, J G. (2013). Overt irritability/anger in unipolar major depressive episodes: past and current characteristics and implications for long-term course. JAMA Psychiatry, 70(11), 1171-1180.
HARPREET S. DUGGAL, MD, FAPA