Anger attacks in major depressive disorder tied to elevated irritability

Persistently elevated irritability appears to be an important symptom of major depressive disorder (MDD) and is associated with overt anger behaviour, as reported in a recent study.

The study involved 293 adults with MDD participating in the 8-week Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care (EMBARC) study, among whom 149 had been randomized to receive placebo and 144 sertraline. All participants completed the Massachusetts General Hospital Anger Attacks questionnaire. Researchers measured depression, anxiety and irritability using the 17-item Hamilton Depression Rating Scale and the 16-item Concise Associated Symptom Tracking scale at each visit.

About 37 percent (n=109) of the population reported anger attacks, among whom 44, 32, 19 and 14 patients had 1–2, 3–4, 5–8 and ≥9 attacks in past 1 month, respectively. Patients with anger attacks had similar levels of depression but higher levels of irritability compared with those who had no anger attacks.

Antidepressant treatment led to a greater reduction in irritability (p<0.001) but not in depression (p=0.813) or anxiety (p=0.771) among patients with vs without anger attacks.

At week 8, however, irritability levels were higher in the group with anger attacks. A similar pattern of results was noted in participants with aggressive behaviours (eg, physically/verbally attacking people, throwing things around/destroying objects).

The findings indicate that the presence of anger attacks in MDD may identify a subgroup of patients who have persistently elevated irritability despite antidepressant treatment, the researchers said.