Thursday, September 26, 2013

Study Finds Depression With Irritability, Anger Points to Poorer Prognosis

People whose major depression is accompanied by irritability and anger have a more unfavorable prognostic outlook than do people who have a major depression without those two additional factors, a large prospective study published in JAMA Psychiatry has found. The lead researcher was Lewis Judd, M.D., of the University of California, San Diego.

The researchers followed 536 subjects with major depression, half of whom also experienced irritability and anger, for an average of 16 years and compared the outcomes for the two groups. The irritability group took significantly longer than the depression-alone group to recover from the major depression they had at the study's onset. Furthermore, during the years of follow-up, they were significantly more likely than the depression-alone group to experience affective symptoms or a major affective episode; to have substance use disorders or anxiety disorders; to have difficulties with their partners or trouble performing at work or school; and to experience a lower quality of life. The study was funded by the National Institute of Mental Health.

"It is important for clinicians to identify overt irritability/anger in patients who experience a major depressive episode, because such symptoms are a clinical marker for a significantly more complex, chronic, and severe form of major depression," Judd and his colleagues emphasized.

Although DSM-5 does not include a subtype of major depression accompanied by anger and irritability, it does reflect an effort to move the depressive disorders away from a strict categorical designation to a more dimensional approach where depressive disorders can present with different degrees of severity and in the presence of comorbid symptoms, said Jan Fawcett, M.D., chair of the DSM-5 Mood Disorders Work Group, in interview with Psychiatric News.

For more information on this topic, see the Psychiatric News article "DSM-5 Updates Depressive, Anxiety, and OCD Criteria." Also see the Psychiatric Services article "The Diagnosis of Anger as a Presenting Complaint in Outpatient Medical Settings."

(image: fasphotographic/


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