Overt Irritability/Anger in Unipolar Major Depressive Episodes

Abstract

IMPORTANCE Although symptoms of irritability or anger are not central to the diagnosis of unipolar major depressive episodes (MDEs), these symptoms have been found, in cross-sectional studies, to be highly prevalent and associated with increased comorbidity and depressive illness burden.OBJECTIVE To determine the prevalence of overtly expressed irritability/anger and its effect on intake presentation and the long-term course of illness. DESIGN A prospective, naturalistic investigation of patients with unipolar MDEs, studied systematically at intake and during up to 31 years of follow-up. SETTING Five US academic medical centers.

The effects of co-morbidity in defining major depression subtypes associated with long-term course and severity

“…Although a number of previous epidemiological studies examined baseline predictors of long-term depression course in treatment samples (Judd et al ., 2013; Penninx et al ., 2008) or community samples (Bottomley et al ., 2010; Patten et al ., 2010; Rhebergen et al ., 2012), none searched for depression subtypes among predictors. As noted in the introduction, though, other subtyping analyses similar to those reported here have been carried out, including analyses to predict treatment response (Andreescu et al ., 2008; Jain et al ., 2013) and naturalistic patterns of remission among patients in treatment (Riedel et al ., 2011) as well as in the placebo control group of a depression clinical trial (Nelson et al ., 2012).…”

What are 'good' depression symptoms? Comparing the centrality of DSM and non-DSM symptoms of depression in a network analysis

“…The main goals of this article are (A) to explore the centrality of a large number of depressive symptoms, and (B) to compare the centrality of the DSM criteria with the centrality of non-DSM symptoms such as anxiety and irritability that are highly prevalent in depressed samples and associated with worse clinical trajectories (Fava et al, 2008;Judd et al, 2013).…”

Hostile interpretation bias in depression

“…Problematic anger and hostility have been highlighted as severity markers for the course of depression, and epidemiological studies have linked high levels of anger to a more chronic, comorbid, and symptomatic presentation (Benazzi & Akiskal, 2005;Fava et al, 2010;Judd, Schettler, Coryell, Akiskal, & Fiedorowicz, 2013;Perlis et al, 2009). Theoretically, this link can be understood through an interpersonal lens, in which problematic anger is implicated as a potential social repellent that may diminish an individual's support network and contribute to feelings of isolation and worthlessness (Coyne, 1976;Joiner & Metalsky, 1995). Hostility is considered a cognitive component of anger which, at high levels, is theorized to cause individuals to be habitually suspicious of others and to behave in a defensive or aggressive manner toward others due to -often erroneously -perceived threat (Moreno, Fuhriman, & Selby, 1993;Riley, Treiber, & Woods, 1989).…”