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 are 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 about 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 circumstances such as the birth of a child, their normal grieving process is interrupted. A few months down the road, they start to get irritable and snappy with their family and coworkers, feel tired most of the time, experience insomnia, no longer enjoy pleasurable things as they used to, and are 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, try to identify any fixed beliefs or assumptions associated
with these emotions that you may be harboring. In the previous example, the
person may harbor the belief that they haven’t been a good son or daughter to their parents, even though there is no evidence to support it. 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.
To learn more about evidence-based self-management
techniques that are proven to work for depression, check out Dr. Duggal's Author Page.
HARPREET S. DUGGAL, MD, FAPA
REFERENCES
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.
That kind of anger us like an approaching train...and if left unattended to, it may manifest itself and met the depression headon.
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