Irritability and depression

This week's blog post is by the lovely Nishi, our welfare officer

People often associate depression with sadness, hopelessness, and persistent anxiety, but irritability and anger are often overlooked. Irritability associated with depression is rarely mentioned in psychological literature, this symptom is often mistaken as a sign of other mental health disorders such as bipolar disorder.

However recently, after the longstanding misconception that irritability is symptom of depression in younger children only, it has started to be recognised as a symptom for depression in all age groups. Irritability in depression can be defined as being argumentative or becoming angry at things you usually would not get angry at.

Persistent irritability can last for days or weeks, often creating difficulties for people with depression when it comes to managing relationships.

A 2011 study in the Netherlands on the clinical and physiological correlates of irritability in depression presented the following findings:

1. 50% of patients with unipolar depression had high levels of irritability.

2. Prevalence of anger attacks in in patients with unipolar depression was 40%.

3. Irritable depressed patients were more severely depressed than non-irritable depressed patients. Severity of anxiety symptoms was also higher in irritable depressed patients and they were also more likely to be diagnosed with a comorbid anxiety disorder.

4. Irritable depressed patients had higher levels of aggression reactivity and hopelessness which are associated with an increased risk of suicide.

In the future more studies will look at the link between irritability and bipolar disorder and if high levels of irritability in depressed patients can lead to a higher risk of the disorder later in life.

What does this mean for doctors and medical students currently? Increasing awareness of the link between irritability and depression must be applied to practice directly. Asking patients who present with symptoms of depression about their feelings of anger and irritability can extract more information about the their overall wellbeing.