Anger is seldom recognised as a symptom of depression, but the experts say a growing number of sufferers often find themselves in the grip of unrelenting rage.
When you think of depression, you're more likely to conjure up images of a melancholic person who can't eat and spends a lot of time in bed than of someone who has a short-fuse, snaps a lot and exhibits uncontrollable rage. However, what many don't know is that anger can play a starring role in depression.
While much of the literature surrounding the disorder doesn't mention anger and rage as being symptoms, mental health specialists are increasingly reporting on angry behaviour and irritability in patients who are suffering from depression. So, if you're feeling unusually short-tempered and have experienced an increase in anger, how can you know whether this may be indicative of a more serious underlying problem such as depression?
What is depression?
Depression is more than just feeling 'low' or 'blue' for a few days - its symptoms persist and interfere with the daily lives of those who suffer from it. The experience of the disorder varies greatly from person-to-person. Some report that it feels like a black cloud has descended on them, while others say they have no energy, they can't concentrate and can't bring themselves to eat. Other symptoms can include the loss of interest or pleasure in activities that were once enjoyed, anxiety, difficulty sleeping, oversleeping, and feelings of worthlessness.
While each sufferer's symptoms differ, mental healthcare specialists agree that if you have been experiencing some of the above for more than two weeks and these feelings are interfering with your life, then you may be clinically depressed.
"There isn't a magic number of symptoms that someone has to have to be diagnosed with depression," explains Dr Kennon Rider, director of early childhood education, Michigan State University, Dubai. "As a professional, you just get a feel for it. It can often be difficult to diagnose, as it presents differently in different people. In general, when people come to see me, they often don't come because they think they're depressed - they come to talk about their relationship or their anger and through what they are saying I can pick up on their symptoms."
What is anger?
According to Dr Rider, anger can be defined as an act of displeasure or hostility to a perceived injustice. While it is an unpleasant emotion, it isn't always a bad or a negative experience. For example, mild episodes of anger can sometimes motivate people to listen to your concerns, or it can encourage you to get involved in causes that you care about.
At the more extreme end of the range, anger can be destructive and is what mental healthcare specialists refer to as 'problem' anger. The Mental Health Organisation defines this as, 'any dysfunctional way of relating to and managing anger that persistently causes significant difficulties in a person's life, including their thinking, feeling, behaviour and relationships'. According to a survey by the organisation, almost a third of people polled say they have a close friend or family member who has trouble controlling their anger and more than one in ten say they have trouble controlling their own. Sixty four per cent either "strongly agree" or "agree" that they believe people in general are getting angrier.
How are anger and depression linked?
The idea that depression is 'anger turned inwards' was first explored by psychoanalyst Sigmund Freud, and consequently many have continued to look at the relationship between the two. Dr Fred Busch, clinical associate professor of psychiatry at Weil Cornell Medical College, researched the link between the two in his paper, Anger and Depression, which was published in the journal, Advances in Psychiatric Treatment. He believes that depression can fuel anger, as patients with low self-esteem tend to feel easily rejected by others and have angry reactions to this rejection.
His research also suggests that while some patients experience an increase in episodes of anger, others will find their anger is suppressed. "Angry feelings often trigger guilt, self-criticism and anxiety that will be destructive to relationships," he explains. "Guilt and self-criticism are forms of anger directed inward and can add to a depressive mood. Research on the presence of anger in depression suggests that depressed patients can have either an excess of expressed anger or a suppression of angry feelings."
Amy Felton* has suffered from depression on and off for more than 30 years and says she experiences unusual feelings of anger whenever she happens to stop taking her anti-depressants. In one scenario, Amy describes how, sitting at her desk at work one day, she felt an overwhelming desire to shout at everyone and tell them to 'leave her alone', despite the fact no one was talking to her at the time. Other examples include having a short temper in non-threatening situations, such as while in general conversation with a colleague. "It was my therapist who first told me that depression is anger turned inward," says Amy. "That makes so much sense to me. When I'm off my anti-depressants, my anger flares. It still doesn't go outwards significantly, as I now know better ways in which to handle it than turn it on myself or others. If I ignore the warnings, however, I find myself sinking again and talking to myself in ways I would never talk to anyone else."
Despite the fact there is a breadth of research that suggests anger can be identified as a symptom of depression, it isn't listed in the DSM IV (manual used to diagnosed mental illness) criteria for the disorder. "Throughout my career, recognising anger as a symptom of depression has been my most important lesson about the illness," says Dr Rider. "I believe that the research literature is gradually showing and recognising this connection. I also feel strongly that people should consider depression as a possibility when they see an increase in anger."
What to look out for
It is possible to view an increase in anger as a symptom of depression, but the crucial thing that you need to remember is that it needs to represent a change in your usual behaviour. For example, if there was a time when a small issue would pass as a simple annoyance, whereas now you're very angered by it, this represents a change, a signal that something is not OK in your world. "If you feel that you have become short-fused and that you're persistently becoming easily angered, I'd suggest you try and see whether you're experiencing any of the other symptoms of depression, such as feelings of hopelessness and worthlessness," says Dr Rider. "You should also ask yourself if there's a history of depression in your family and what it is in your circumstances that you may not be thinking about or confronting."
Dr Toni Galardi, psychotherapist and author of The LifeQuake Phenomenon: How To Thrive in Times of Personal and Global Upheaval (Wheatmark), has explored the link between anger and depression in her book, and believes that they can be responses to life transitions and changes. She suggests trying a stress management exercise that will help you manage your anger and also identify whether or not you need to seek help for your symptoms.
Galardi says before you go to bed each night, you should sit for 15 minutes in a quiet spot with no distractions and scan back over your entire day. You should pay attention to what you were feeling from the beginning to the end, like you are watching a movie. At every juncture where anger came up, pause and ask yourself, what was I really feeling at that moment? If I could replay that experience, how would I do it differently? And lastly, what change can I institute in my life that will allow me to have a more adaptive response to outer stressors? For example, if you always leave for work a few minutes late and you get worked up over a traffic jam, by getting up a little earlier you could make the transition from home to work easier.
If you're finding yourself more impatient with your co-workers or employees, Galardi suggests you ask yourself if you're burnt out or if it's time to move onto something new. "If in asking these questions you realise you need assistance in creating a new life strategy, then it might be time to contact a psychotherapist. If you're becoming incapacitated, for example, by staying in bed all day or not attending to most of your responsibilities, then it might be useful to be evaluated by a psychiatrist who can prescribe anti-depressants to re-balance your brain chemistry," she says.
