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Relationship of anger and anger attacks with depression

A brief review

  • BRIEF REVIEW
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Abstract

Anger is a common and potentially destructive emotion that has considerable social and public health importance. The occurrence of anger, irritability and hostility in depression have been known for many years, but the prevalence, significance for treatment and prognosis and the mechanisms involved remain poorly understood. More recently, anger attacks have been proposed as a specific form of anger in depression. They are characterized by a rapid onset of intense anger and a crescendo of autonomic arousal occurring in response to trivial provocations. Though the presence or absence of hostility, anger and aggression in depression has been a matter of controversy, anger attacks have been found to occur more often in depressed patients in comparison to healthy controls. Some studies have reported that depressed patients with anger attacks differ from those without such attacks in terms of clinical profile, comorbid personality disorders and certain biological variables. Serotonergic dysfunction may characterize this distinct subtype of depression – depression with anger attacks.

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References

  1. Abraham K (1927) Notes on the psychoanalytic investigation and treatment of manic-depressive insanity and allied conditions: Selected papers. Hogarth Press, London

  2. Akiskal HS, Benazzi F (2003) Family history validation of the bipolar nature of depressive mixed states. J Affect Disord 73:113–122

    Article  PubMed  Google Scholar 

  3. Alpert JE, Petersen T, Roffi PA, Papakostas GI, Freed R, Smith MM, Spector AR, Nierenberg AA, Rosenbaum JF, Fava M (2003) Behavioral and emotional disturbances in the offspring of depressed parents with anger attacks. Psychother Psychosom 72:102–106

    Article  PubMed  Google Scholar 

  4. American Psychiatric Association (1994) Diagnostic and Statistical Manual ofMental Disorders, Ed 4. American Psychiatric Association, Washington DC

  5. Bagby RM, Kennedy SH, Dickens SE, Minifie CD, Schuller DR (1997a) Personality and symptom profiles of the angry hostile depressed patients. J Affect Disord 45:155–160

    Article  Google Scholar 

  6. Bagby RM, Kennedy SH, Schuller DR, Dickens SE, Minifie LE, Levitt A, et al. (1997b) Differential pharmacological treatment response in high angry hostile and low angry hostile depressed patients: a retrospective analysis. J Affect Disord 45:161–166

    Article  Google Scholar 

  7. Beasley CM, Dornseif BE, Bosomworth JC, Sayler ME, Rampey AH, Heilgenstein JH, et al. (1991) Fluoxetine and suicide: a metaanalysis of controlled trials of treatment for depression. BMJ 303:685–692

    PubMed  Google Scholar 

  8. Benazzi F (2003) Anger in bipolar depression. J Clin Psychiatry 64:480–481

    PubMed  Google Scholar 

  9. Benazzi F, Akiskal HS (2001) Delineating bipolar II mixed state in the Ravenna-San Diego collaborative study: the relative prevalence and diagnostic significance of hypomanic features during major depressive episodes. J Affect Disord 67:115–122

    Article  PubMed  Google Scholar 

  10. Berner P, Kufferle B (1982) British phenomenological and psychological concepts: a comparative review. Br J Psychiatry 140:558–565

    PubMed  Google Scholar 

  11. Biaggio MK, Godwin WH (1987) Relation of depression to anger and hostility constructs. Psychol Rep 61:87–90

    PubMed  Google Scholar 

  12. Biglan A, Hops H, Sherman L, Friedman L, Arthur J, Osten V (1985) Problem-solving interactions of depressed women and their husbands. Beh Ther 16:431–451

    Google Scholar 

  13. Blackburn IM, Lyketsos G, Tsiantis J (1979) The temporal relationship between hostility and depressed mood. Br J Soc Clin Psychol 18:227–235

    PubMed  Google Scholar 

  14. Brody CL, Hagga DAF, Kirk L, Solomon A (1999) Experience of anger in people who have recovered from depression and never depressed people. J Nerv Ment Dis 187:400–405

    Article  PubMed  Google Scholar 

  15. Brown GL, Ebert MH, Goyer PF (1982) Aggression, suicide and serotonin: relationship to CSF amine metabolites. Am J Psychiatry 139:741–746

    PubMed  Google Scholar 

  16. Buss AH, Durkee A (1957) An inventory for assessing different kinds of hostility. J Consult Psychol 21:343–349

    PubMed  Google Scholar 

  17. Campbell RJ (1996) Psychiatric Dictionary, Ed 7. Oxford University Press, New York

  18. Coccaro EF, Siever LJ, Klar HM, Maurer G, Cocchrane K, Cooper TB (1989) Serotonergic studies in patients with affective and personality disorders: correlates with suicidal and impulsive aggressive behavior. Arch Gen Psychiatry 46:587–599

    PubMed  Google Scholar 

  19. Cook WW, Medley DM (1954) Proposed hostility and pharisaic virtu scales for the MMPI. J Applied Psychol 38:414–418

    Google Scholar 

  20. Craig TJ, Richardson MA, Pass R, Bregman Z (1985) Measurement of mood and affect in schizophrenic inpatients. Am J Psychiatry 142:1272–1277

    PubMed  Google Scholar 

  21. Deffenbacher JL (1992) Trait anger: theory, findings and implications. In: Spielberger CD, Butcher JN (eds) Advances in Personality Assessment, Vol. 9. Erlbaum, Hillsdale

  22. Elliott FA (1984) The episodic dyscontrol syndrome and aggression. Neurol Clin 2:113–125

    PubMed  Google Scholar 

  23. Fava GA (1999) Subclinical symptoms in mood disorders: Pathophysiological and therapeutic implications. Psychol Med 29:47–61

    Article  PubMed  Google Scholar 

  24. Fava M, Alpert J, Nierenberg AA (1996) Fluoxetine treatment of anger attacks: a replication study. Ann Clin Psychiatry 8:7–10

    PubMed  Google Scholar 

  25. Fava M, Anderson K, Rosenbaum JF (1990) Anger attacks: possible variants of panic and major depressive disorders. Am J Psychiatry 147:867–870

    PubMed  Google Scholar 

  26. Fava M, Anderson K, Rosenbaum JF (1993a) Are thymoleptic-responsive “anger attacks” a discrete clinical syndrome? Psychosomatics 34:350–355

    Google Scholar 

  27. Fava GA, Kellner R, Lisansky J, Park S, Perini GI, Zielezny M (1986) Hostility and recovery from melancholia. J Nerv Ment Dis 174:414–417

    PubMed  Google Scholar 

  28. Fava GA, Kellner R, Perini GI (1982) Losses, hostility and depression. J Nerv Ment Dis 170:474–478

    PubMed  Google Scholar 

  29. Fava M, Nierenberg AA, Quitkin FM, Zisook S, Pearlstein T, Stone A (1997) A preliminary study on the efficiency of sertraline and imipramine on anger attacks in atypical depression and dysthymia. Psychopharmacol Bull 33:101–103

    PubMed  Google Scholar 

  30. Fava M, Rappe SM, West J, Herzog DB (1995) Anger attacks in eating disorders. Psychiatric Res 56:205–212

    Article  Google Scholar 

  31. Fava M, Rosenbaum JF (1997) Anger attacks in depression. Depression Anxiety 6:1–5

    Google Scholar 

  32. Fava M, Rosenbaum JF (1999) Anger attacks in patients with depression. J Clin Psychiatry 60(Suppl 15):21–24

    Google Scholar 

  33. Fava M, Rosenbaum JF, McCarthy M, Herzog DB (1993b) Anger attacks in depressed outpatients and their response to fluoxetine. Psychopharmacol Bull 29:275–288

    Google Scholar 

  34. Fava M, Rosenbaum JF, McCarthy M, Pava J, Steingard R, Bless E (1991) Anger attacks in depressed outpatients and their response to fluoxetine. Psychopharmacol Bull 27:275–279

    PubMed  Google Scholar 

  35. Fava M, Rosenbaum JF, Pava JA, McCarthy MK, Steingard RJ, Bouffides E (1993c) Anger attack in unipolar depression, Part 1: clinical correlates and response to fluoxetine treatment. Am J Psychiatry 150:1158–1163

    Google Scholar 

  36. Fava GA, Ruini C, Sonino N (2003) Management of recurrent depression in primary care. Psychother Psychosom 72:3–9

    Article  PubMed  Google Scholar 

  37. Fava M, Vuolo RD, Wright EC, Nierenberg AA, Alpert JE, Rosenbaum JF (2000) Fenfluramine challenge in unipolar depression with and without anger attacks. Psychiatric Res 94:9–18

    Article  Google Scholar 

  38. Feldman LA, Gotlib IH (1993) Social dysfunction. In: Costello CG. Symptoms of depression. Wiley, New York

  39. Freud S (1917) Mourning and Melancholia. In: Jones E (1956) Collected Papers. Hogarth Press, London

  40. Friedman AS (1970) Hostility factors and clinical improvement in depressed patients. Arch Gen Psychiatry 23:524–537

    PubMed  Google Scholar 

  41. Goldman L, Hagga DAF (1995) Depression and the experience and expression of anger in marital and other relationships. J Nerv Ment Dis 183:505–509

    PubMed  Google Scholar 

  42. Gottschalk LA, Gleser GC, Springer KJ (1963) Three hostility scales applicable to verbal samples. Arch Gen Psychiatry 9:245–279

    Google Scholar 

  43. Gould RA, Ball S, Kaspi SP (1996) Prevalence and correlates of anger attacks: a two site study. J Affect Disord 39:31–38

    Article  PubMed  Google Scholar 

  44. Gupta R (1987) An exploratory study of guilt and hostility in depression. Postgraduate Institute of Medical Education and Research, Chandigarh (Unpublished M.D., Thesis)

  45. Harburg E,Erfurt JC,Hauenstein LS, Chape C, Schull WJ, Schork MA (1973) Socio-ecological stress, suppressed hostility, skin colour, and black-white male blood pressure. Psychosom Med 35:276–296

    PubMed  Google Scholar 

  46. Healy D (2003) Lines of evidence on the risks of suicide with selective serotonin reuptake inhibitors. Psychother Psychosom 72:71–79

    Article  PubMed  Google Scholar 

  47. Hollister LE, Alto P, Galveston T, Johnson M (1966) Amitriptyline alone and combined with perphenazine in newly admitted depressed patients. J Nerv Ment Dis 142:460–469

    PubMed  Google Scholar 

  48. Hollister LE, Overall JE, Shelton J, Alto P, Pennington V, Kimbell I (1967) Drug therapy of depression: amitriptyline, perphenazine and their combination in different syndromes. Arch Gen Psychiatry 17:486–493

    PubMed  Google Scholar 

  49. Jain U, Leslie VC, Keefe BR (1997) Anger attacks in bipolar depression versus unipolar depression. In: New research program and abstracts of the 150th Annual Meeting of the American Psychiatric Association. American Psychiatric Association, San Diego

  50. Kassinove H, Sukhodolsky DG,Eckhardt CI,Tsytsarev SV (1997) Development of Russian state-trait anger expression inventory. J Clin Psych 53:543–557

    Google Scholar 

  51. Kendell RE (1970) Relationship between aggression and depression: epidemiological implications of a hypothesis. Arch Gen Psychiatry 22:308–318

    PubMed  Google Scholar 

  52. Kennedy HG (1992) Anger and irritability. Br J Psychiatry 161:145–153

    PubMed  Google Scholar 

  53. Khan A, Khan S, Kolts R, Brown WA (2003) Suicide rates in clinical trials of SSRIs, other antidepressants, and placebo: analysis of FDA reports. Am J Psychiatry 160:790–793

    Article  PubMed  Google Scholar 

  54. Klerman GL, Gershon ES (1970) Imipramine effects upon hostility in depression. J Nerv Ment Dis 150:127–132

    PubMed  Google Scholar 

  55. Kretschmer E (1927) The sensitive delusion of reference. In: Hirsch SR, Shepherd M (1974) Themes and Variations in European Psychiatry. Wright, Bristol

  56. Lane RM (1998) SSRI-induced extrapyramidal side-effects and akathesia: implications for treatment. J Psychopharmacol 12:192–214

    PubMed  Google Scholar 

  57. Mammen OK, Shear MK, Pilkonis PA, Kolko DJ, Thase ME, Greeno CG (1999) Anger attacks: correlates and significance of an underrecognized symptom. J Clin Psychiatry 60:633–642

    PubMed  Google Scholar 

  58. Mayo PR (1978) Some psychological changes associated with improvement in depression. Br J Soc Clin Psychol 8:145–149

    Google Scholar 

  59. Mischoulon D, Dougherty DD, Bottonari KA, Gresham RL, Sonawalla SB, Fischman AJ, Fava M (2003) An open pilot study of nefazodone in depression with anger attacks: relationship between clinical response and receptor binding. Psychiatry Res 116:151–161

    Google Scholar 

  60. Musalek M, Griengl H, Hobl B, Sachs G, Zoghlami A (2000) Dysphoria from a transnosological perspective. Psychopathology 33:209–214

    Article  PubMed  Google Scholar 

  61. Muscatello CF, Scudellari P (2000) Anger and narcissism: between the void of being and the hunger for having. Psychopathology 33:227–232

    Article  PubMed  Google Scholar 

  62. Novaco RW (1975) Anger control: the development and evaluation of an experimental treatment. DC, Health & Co, Lexington

    Google Scholar 

  63. Paykel ES (1971) Classification of depressed patients. A cluster analysis derived grouping. Br J Psychiatry 118:275–288

    PubMed  Google Scholar 

  64. Perris C, Eismann M, Ericsson U, von Knorring L, Perris H (1983) Patterns of aggression in the personality structure of depressed patients. Arch Fur Psychiatric Nervenkr 233:89–102

    Article  Google Scholar 

  65. Pilowsky I, Spence ND (1975) Hostility and depressive illness. Arch Gen Psychiatry 32:1154–1159

    PubMed  Google Scholar 

  66. Riley WT, Treiber FA, Woods G (1989) Anger and hostility in depression. J Nerv Ment Dis 177:668–675

    PubMed  Google Scholar 

  67. Rosenbaum JF, Fava M, Pava JA, McCarthy MK, Steingard RJ, Bouffides E (1993) Anger attacks in unipolar depression, Part II: Neuroendocrine correlates and changes following fluoxetine treatment. Am J Psychiatry 150:1164–1168

    PubMed  Google Scholar 

  68. Rubey RN, Johnson MR, Emmanuel N, Lydiard B (1996) Fluoxetine in the treatment of anger: An open clinical trial. J Clin Psychiatry 57:398–401

    PubMed  Google Scholar 

  69. Saletu B, Grunberger J, Linzmayer L (1986) On central effects of serotonin reuptake inhibitors: quantitative EEG and psychometric studies with sertraline and zimelidine. J Neural Transm 67:241–266

    Article  PubMed  Google Scholar 

  70. Sayar K, Guzelhan Y, Solmaz M, Ozer OA, Ozturk M, Acar B (2000) Anger attacks in depressed Turkish outpatients. Ann Clin Psychiatry 12:13–18

    Google Scholar 

  71. Schatzberg AF, deBattista C (1999) Phenomenology and treatment of agitation. J Clin Psychiatry 60(Suppl 15):17–20

    PubMed  Google Scholar 

  72. Schless AP, Mendels J, Kipperman A, Cochrane C (1974) Depression and hostility. J Nerv Ment Dis 159:91–100

    PubMed  Google Scholar 

  73. Seigel JM (1986) The Multidimensional Anger Inventory. J Pers Soc Psychol 51:191–200

    PubMed  Google Scholar 

  74. Sethi BB, Prakash R, Arora U (1980) Guilt and hostility in depression. Indian J Psychiatry 22:156–160

    Google Scholar 

  75. Snaith RP, Taylor CM (1985) Irritability: Definition, assessment and associated factors. Br J Psychiatry 147:127–136

    PubMed  Google Scholar 

  76. Spielberger CD, Sydeman S (1994) State-Trait Anxiety Inventory and State-Trait Anger Expression Inventory. In: Maurish ME (ed) The use of psychological tests for treatment, planning and outcome assessment. Hillsdale, New Jersey

  77. Spitzer RL, Endicott J (1979) Schedule for Affective Disorders and Schizophrenia (SADS). New York State Psychiatric Institute, New York

  78. Spitzer RL, Endicott J, Robin E (1978) Research Diagnostic Criteria (RDC). Biometrics Research, New York

  79. Tangney JP, Wagner PE, Marschall D, Gramzow R (1991) The Anger Response Inventory (ARI). George Mason University, Fairfax

  80. Tedlow JR, Leslie VC, Keefe BR (1997) Are anger attacks in unipolar depression a variant of panic disorder? In: New research program and abstracts of the 150th Annual Meeting of the American Psychiatric Association, American Psychiatric Association, San Diego

  81. Tranter R, Healy H, Cattell D, Healy D (2002) Functional effects on agents differentially selective to noradrenergic or serotonergic systems. Psychol Med 32:517–524

    Article  PubMed  Google Scholar 

  82. Trivedi JK, Dube S, Raz R, Sethi BB (1981) A comparative study of guilt and hostility in depressive subjects. Indian J Psychiatry 23:156–159

    Google Scholar 

  83. van Valkenburg C, Akiskal HS, Puzantian V (1984) Anxious depression: clinical, family history and naturalistic outcome – comparisons with panic and major depressive disorders. J Affect Disord 6:67–82

    Article  PubMed  Google Scholar 

  84. Weissman MM, Klerman GL, Paykel ES (1971) Clinical evaluation of hostility in depression. Am J Psychiatry 128:261–266

    PubMed  Google Scholar 

  85. White RB (1977) Current psychoanalytic concepts of depression. In: Fann WE, Karacan I, Pokomy AD, Williams RL (eds) Phenomenology and Treatment of Depression. Spectrum, New York

  86. Wing JK, Cooper JE, Sartorius N (1974) The measurement and classification of psychiatric symptoms. Cambridge University Press, London

  87. World Health Organization (1992) ICD-10 Classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. World Health Organization, Geneva

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Painuly, N., Sharan, P. & Mattoo, S.K. Relationship of anger and anger attacks with depression. Eur Arch Psychiatry Clin Neurosci 255, 215–222 (2005). https://doi.org/10.1007/s00406-004-0539-5

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