Depression is associated with fatigue and melancholy, but there’s another often overlooked symptom of depression, professionals say—anger.
Some medical providers, including psychiatrist Maurizio Fava, who practices at Massachusetts General Hospital and teaches at Harvard Medical School, would like to see anger included as a symptom of depression in the Diagnostic and Statistical Manual of Mental Disorders (DSM).
“[Anger is] not included at all in the adult classification of depression,” Fava told NPR, despite the fact that it is a listed symptom of depression for children and teens. “Why would someone who happens to be irritable and angry when depressed as an adolescent suddenly stop being angry at age 18?”
Because anger isn’t listed as a symptom of depression, people who present with anger as a primary symptom can be misdiagnosed.
“We see in our clinics patients who are labeled as having other diagnoses because people think, ‘Well, you shouldn’t be so angry if you are depressed,’” Fava said.
Still, he said about 1 in 3 patients have told him about angry outbursts associated with depression, something Fava calls “anger attacks.”
“They would lose their temper, they would get angry, they would throw things or yell and scream or slam the door,” he said.
Fava would like the medical community to study anger more closely in order to fully understand depression.
“I don’t think that we have really examined all the variables and all the levels of anger dysregulation that people experience,” he said.
Mark Zimmerman, who teaches psychiatry at Brown University, conducted a poll in which two-thirds of people seeking first-time psychiatric treatment reported feelings of anger. The fact that anger associated with mental illness, specifically depression, hasn’t been studied means it is hard to know what treatment might work to alleviate this symptom.
“The most frequently used scales to evaluate whether or not medications work for treating depression don’t have any anger-specific items,” Zimmerman said.
Kevin Einbinder, who handles communications for the Depression and Bipolar Support Alliance, said that looking back over his life he can see that anger played a big role in many of his relationships, although he didn’t realize it until a journalist posed the question.
“I thought of all the people in my life who have interacted with me—my family, the counselors, psychiatrists, even employers, significant others, and I realized that anger was an underlying factor in all those relationships,” Einbinder said.
If he had realized this at the time, or if his providers had known to ask about this symptom, he could have learned to cope with it earlier on, he said.
“I think that would have provided a tremendous amount of context for what’s adding to my depression and in helping me, early on in my life, with more effective coping mechanisms.”
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