By Dr. David Woo - January 1, 2021

Anger is often a symptom of depression, though it’s one that’s less commonly recognized by depression sufferers as being related to their depression. Anger and irritability are reported in as many as one-third of patients with depression. (1) One study noted an even higher incidence (53.4%) of anger and irritability among patients experiencing a depressive episode. (2)

Anger is a natural and healthy emotion that, when properly managed, can be useful in helping people make positive changes in their lives. However, anger that is not managed properly can lead to problems in relationships and at work. Prolonged feelings of irritability or anger may be a sign of depression.

The Role of Anger in Depression

The relationship between anger and depression is not fully understood. Depression is a complex emotional condition that develops as a result of and is influenced by many factors. However, researchers have gained some understanding of the relationship between depression and anger:

• Patients diagnosed with depression, and other emotional disorders, who express elevated anger and irritability experience greater symptom severity and may be less likely to respond to treatment. (3)

• Symptoms of anger and irritability are associated with a longer duration of the depressive episode, increased severity of depression, poorer impulse control, and higher rates of substance abuse. (2)

• Irritable mood is seen more often in patients of younger age and in females. (2) 

• Turning anger inward (for example, engaging in self-criticism) can contribute to the severity of depression. (4) 

• Patients with depression who lack the ability to regulate their emotions and, as a result, ruminate on negative experiences are more likely to exhibit anger. (5)

• Men with depression are more likely to outwardly express anger. This, in addition to the fact that men are less likely to talk about their feelings and ask for help, may explain why depression in men can often go unnoticed. (6)

Treatment Can Help Relieve Anger and Other Symptoms of Depression

If symptoms of depression such as anger and irritability are affecting your relationships, your job, and/or your daily life, talk to your doctor or therapist. Prolonged anger and depression aren’t an inevitable part of life. With the right treatment, you can reduce feelings of anger and also relieve the negative effects it has on your life.

Antidepressant medication is an effective depression treatment, especially for patients with moderate, severe, and chronic depression. (7) Patients may need to take antidepressants for a  few weeks before they see results. Since there are different types of antidepressants, patients may need to try different types before finding the right medication for them. 

Transcranial magnetic stimulation (TMS) is an alternative depression treatment option for patients who do not respond to antidepressants or for patients who wish to avoid the side effects associated with antidepressants. TMS is a non-invasive, medication-free treatment that uses magnetic pulses to stimulate brain regions associated with depression. Learn more about TMS here.

Talk therapies, like problem-solving therapy, cognitive-behavioral therapy, and interpersonal therapy, can help patients regulate their emotions and practice managing anger in a healthy way. Repression and explosion are unhealthy ways to manage anger. Some healthy ways to manage anger include:

• Identifying the trigger(s)
• Practicing forgiveness
• Distracting yourself from negative ruminating thoughts

The most effective treatment for depression that manifests with anger is a combination of medical treatment (either with antidepressants or TMS) and talk therapy. 

Resources:

1. Fava M. Depression with anger attacks. J Clin Psychiatry. 1998;59 Suppl 18:18-22. https://pubmed.ncbi.nlm.nih.gov/9840194/. Accessed November 24, 2020.

2. Judd LJ, Schettler PJ, Coryell W. Overt Irritability/Anger in Unipolar Major Depressive Episodes

Past and Current Characteristics and Implications for Long-term Course. JAMA Psychiatry. 2013;70(11):1171-80. https://pubmed.ncbi.nlm.nih.gov/24026579/. Accessed November 23, 2020.

3. Cassiello-Robbins C and Barlow DH. 2016. Anger: The Unrecognized Emotion in Emotional Disorders. Clinical Psychology: Science and Practice. 2016; 23(1):66-85. https://onlinelibrary.wiley.com/doi/full/10.1111/cpsp.12139. Accessed November 23, 2020.

4. Abi-Habib R and Luyten P. The role of Dependency and Self-Criticism in the relationship between anger and depression. Personality and Individual Differences. 2013;55(8):921-925. https://www.sciencedirect.com/science/article/abs/pii/S0191886913007526. Accessed November 24, 2020.

5. Besharat MA, Nia ME, and Farahani H. Anger and major depressive disorder: The mediating role of emotion regulation and anger rumination. Asian J Psychiatr. 2013;6(1):35-41. https://pubmed.ncbi.nlm.nih.gov/23380315/. Accessed November 24, 2020.

6. Men and Depression. National Institute of Mental Health. Publication Date Unavailable. Updated January 2017. https://www.nimh.nih.gov/health/publications/men-and-depression/index.shtml#:~:text=Because%20men%20who%20are%20depressed,and%20seek%20treatment%20for%20depression. Accessed November 23, 2020.

7. Depression: How effective are antidepressants? InformedHealth.org — Institute for Quality and Efficiency in Health Care (IQWiG). Published January 28, 2015. Updated June 18, 2020. https://www.ncbi.nlm.nih.gov/books/NBK361016/. Accessed November 24, 2020.

Dr. David Woo

Dr. Woo has been seeing patients in private practice since 2002, always with the goals of combining evidence-based medicine with psychodynamic psychotherapy and collaborating with other mental health professionals to ensure the best possible outcomes for his patients. He has been certified to administer TMS at his practice since 2017. His greatest clinical interests include helping patients suffering from depression, anxiety, and obsessive compulsive disorder.