When I talk to others about depression, most often they’ll mention the signs and symptoms so many of are familiar with: sadness, loneliness, isolation, a low mood, lack of energy, suicidal thoughts and feelings, and disrupted sleep and eating patterns. These are the common signs of depression that most people recognize.
What fewer people recognize are signs of depression when it manifests in an unusual (or hidden) way. Some people with depression become more irritable and angry with virtually every one and everything in their life. They have unaccountable mood swings, and find that nothing their co-workers, friends, family, children, or partner does is right.
What does anger and irritability have to do with depression?
Some professionals like to say, “Depression is anger turned inward.” But what happens when that anger is turned outward, even though the person wouldn’t ordinarily be angry at others? It’s likely that the interaction between depression and anger is far more complex than we realized.
It’s probably more helpful to think of depression not as an illness of mood alone, but rather as an impairment in the regulation of our emotions, as Besharat et al. (2013) note. They summarize the complex relationship between anger and depression at the start of their study:
Evidence has demonstrated a close relationship between anger and depression both in normal and patient populations. Depressed people exhibit more anger suppression than normal people. Evolutionary theories of depression suggest that aroused but arrested defenses of fight (arrested anger) and flight (feelings of entrapment) may be among the important components of depression.
However, it has been recognized that depressed people also experience more anger. Again, in the case of treatment, having some residual symptoms such as anger is related to poor therapeutic outcomes and more relapses in depressed people. Depressed people also [feel] more hostility than the normal population.
In short, many people with depression may be more likely to also experience issues with anger and irritability in ways that most people wouldn’t understand as a component of the person’s depression. How depression symptoms are experienced and experienced may also be due to additional factors, such as culture, environment, and upbringing (see, for example, Plowden et al., 2016).
Depression & Destructive Emotions
In order to better explain this complexity between depression and destructive emotions, researchers decided to explore the underlying relationship between anger and depression (Besharat et al., 2013). Researchers recruited 88 people with major depressive disorder to participate (68 women, 20 men) and administered a battery of tests designed to evaluate their depression, angry feelings, how well they could regulate their emotions, and how much they experienced ruminations about anger.1
We know from other research that people who suffer from depression tend to be negatively biased in their information processing — how they see the world around them. People with depression are more sensitive to cues around them for sadness and dysphoria. When given the chance to interpret neutral, positive, or negative information, they tend to do so as negatively as possible.
After running their statistical analyses, the researchers discovered a few interesting findings. “Anger and depression are related through the mediating role of emotion regulation and anger rumination,” write the researchers. In plain English, this means that a person is more likely to express the angry or irritable signs in depression if they are someone who tends to ruminate on past angry situations, or if they have difficulty in tempering their emotions. Someone who is already quick to anger due to their temperament, culture, or upbringing, for instance, would also be more predisposed to express their depression through anger.
How Can Such Depression Be Treated?
Because this type of depression seems to be centered on two key components — emotion regulation and rumination — it also suggests some low-hanging fruit to target in treatment. Rumination itself seems to predict the likelihood of depression returning in a person, so that’s a very good area for a professional to help a person with in psychotherapy anyway.
Mindfulness-based cognitive therapy seems to be particularly helpful in reducing rumination and ruminative thoughts (Segal et al., 2002; Teasdale et al., 2000). Mindfulness-based cognitive therapy is best learned in psychotherapy one-on-one with a therapist who’s been trained in this type of intervention. However, there are also many helpful sites and books on the topic of mindfulness that could help a person get started.
Emotion regulation may also be helpful in reducing feelings of anger and irritability in depression. There are a number of core strategies in emotional regulation (Leahy et al., 2011):
- Reframing or reappraising a situation — thinking about the emotion or situation causing it in a completely different way
- Suppression — inhibiting the external expression of the emotion, but still experiencing it internally
- Acceptance — accepting the emotion as you’re feeling it, but making a conscious and mindful decision to not act on that feeling
The key to understanding depression is to recognize that it is a complex disorder that may show itself differently in different people. Some depression may be hidden. It’s important to recognize that anger and irritability — especially if it’s a significant change from a person’s usual behavior — may be a sign of depression that needs attention and help.
References
Besharat, Mohammad Ali; Nia, Mahin Etemadi; Farahani, Hojatollah. (2013). Anger and major depressive disorder: The mediating role of emotion regulation and anger rumination. Asian Journal of Psychiatry, 6, 35-41.
Leahy, R.L., Tirch, D., & Napolitano, L.A. (2011). Emotion Regulation in Psychotherapy: A Practitioner’s Guide 1st Edition. The Guilford Press, New York.
Plowden, Keith O.; Adams, Linda Thompson; Wiley, Dana. (2016). Black and blue: Depression and African American men. Archives of Psychiatric Nursing, 30, 630-635.
Segal, Z.V., Williams, M., Teasdale, J.D., 2002. Mindfulness-based Cognitive Therapy for Depression: A New Approach to Preventing Relapse. Guildford Publications, New York.
Teasdale, J.D., Segal, Z.V., Williams, J.M.G., Ridgeway, V.A., Soulsby, J.M., Lau, M.A., 2000. Prevention of relapse/recurrence in major depression by mindfulnessbased cognitive therapy. Journal of Consulting and Clinical Psychology, 68, 615–623.
Footnotes:
- Respectively, the measures used are the Beck Depression Inventory, the Multidimensional Anger Inventory, the Cognitive Emotion Regulation Questionnaire (CERQ), and the Anger Rumination Scale (ARS).
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