You spend the whole day in bed. You haven’t left the house in two weeks. Your self-care is non-existent. You are isolating from others. Your family mentions that you seem depressed. You know something is different, so you agree to seek help.
This scenario is typically how people view someone who deals with depression. It’s easy to identify the common symptoms that professionals focus on.
What about the lesser-known symptoms? What about irritability and anger?
The “bible of psychiatry,” the “Diagnostic and Statistical Manual of Mental Disorders,” doesn’t list anger as one of the core symptoms for major depression. “It’s not included at all in the adult classification of depression,” Dr. Maurizio Fava, a psychiatrist at Massachusetts General Hospital and professor at Harvard Medical School, recently told Minnesota Public Radio reporter Nell Greefieldboyce.
Anger often a symptom in depressed kids
But while it isn’t noted in adults, it is “listed as a core symptom of depression for children and adolescents.”
Many mental health professionals will ask about irritable mood in children and adolescents. Often, parents will note anger and rage from their adolescents who are depressed. While children and adolescents process differently than adults, it is interesting that this is not more widely discussed or known. As noted in the MPR article, the discrepancy is confusing. It’s not as if, on your 18th birthday, the tendency to feel angry when depressed suddenly reaches its expiration date.
Fortunately, additional research is taking a closer look at the anger-depression link.
Dr. Mark Zimmerman, professor of psychiatry at Brown University, and colleagues recently surveyed thousands of first-time patients at the Rhode Island Hospital's outpatient psychiatric practice. All were asked about the level of anger they had felt or experienced in the preceding week.
“Two-thirds of individuals reported notable irritability and anger," Zimmerman reported, "and approximately half reported it at a moderate or severe level." So not only did these clients identify anger, but they also reported experiencing fairly high levels of it.
The article mentioned that, “Another large study by a different research group looked at more than 500 people who had been diagnosed with major depression. It found that more than half showed "overt irritability/anger," and that this anger and irritability appeared to be associated with more severe, chronic depression.
This is significant evidence to support the correlation between anger and depression. While it might not be shocking news to some mental health professionals, it is important to note that anger could indicate depression in a client.
So why does it matter?
Why is this important? Diagnosis helps lead treatment. While the diagnosis is not the only factor that determines therapeutic intervention, it is an important first step in effective treatment.
Let’s look closer at the connection between depression and anger. Can’t pay your bills, so you’re feeling overwhelmed and hopeless? Can’t sleep at night or find out that you’re sleeping all the time? Feeling exhausted, listless and unable to complete your daily tasks? Struggling with feelings of worthlessness or inappropriate guilt every day? Any of these scenarios could rightfully trigger anger. This is why it makes so much sense to ask questions about anger in a depression screening.
Hopefully, the mental health field will continue moving in this direction. It’s too important to ignore.
Anger viewed as more ‘acceptable’ than depression
Another consideration is a client’s ability to identify with varying emotions. For example, you may have heard that anger can be a secondary emotion. This means while you may identify with anger, there is likely another emotion behind it. When digging deeper into your anger, you may be able to identify that you feel angry due to shame, guilt or embarrassment.
Think back to when you were young. Many families don’t share emotions with one another. Even if a family does share emotions, they may teach children only the most basic of feelings. I feel sad. I feel mad. I feel happy. That’s typically the extent of it.
Unfortunately, our society appears to have a view that it’s more appropriate to share anger than sadness. Therefore, someone may more easily identify with anger than other emotions. This appears to be especially true for many male clients who often appear to have been taught to disregard any other emotions.
Whether you feel comfortable with identifying various emotions or not, you may identify with this article. Maybe you yell at your family or impatiently roll your eyes at your coworker. If you sense that your anger might be associated with depression, you are encouraged to seek out needed support. You may decide to see a therapist, meet with your pastor or spiritual leader, or try to prioritize self-care. Whatever you need to help you through. Just know that help is available whenever you are ready for it.
*If you are struggling with suicidal thoughts, help is available. Please call the National Suicide Prevention Lifeline at 1-800-273-8255.*
Kelly Sisson is a Licensed Independent Social Worker at Abound Counseling in Jamestown, N.D. Kelly’s core belief is that life is meant to be lived – not just survived. A practicing social worker since 2009, she has worked to empower clients of all ages as they deal with physical, emotional and substance abuse issues including the aftereffects of trauma.