Tuesday, October 13, 2020

Suicidal Thoughts Elevated Among Depressed Patients Reporting Anger Attacks

People with major depressive disorder (MDD) who often experience sudden bouts of anger—also known as anger attacks—may have elevated levels of suicidal ideation compared with those who do not experience anger attacks, suggests a study in Depression & Anxiety.

“While patients with anger attacks typically experience improvement with antidepressants, previous reports have found new‐onset anger attacks in a small minority of patients,” wrote Manish Kumar Jha, M.D., of the Icahn School of Medicine at Mount Sinai and colleagues. “Thus, there is an urgent need to develop treatment strategies that specifically target anger attacks.”

Jha and colleagues analyzed data from the Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care (EMBARC) study. EMBARC was a 16-week randomized, controlled trial that compared the responses of patients aged 18 to 65 with MDD who took sertraline and/or bupropion with those who took placebo.

The researchers specifically focused their analysis on 293 participants who completed the Massachusetts General Hospital Anger Attack Questionnaire (AAQ) at the start of the EMBARC trial. Through the AAQ, patients reported experiences with anger attacks, including how often the attacks occurred in the past month, physical symptoms that accompanied such attacks (for example, dizziness, shortness of breath, and trembling), and whether the attacks led to aggressive behavior (for example, physically or verbally attacking others). As part of the trial, the participants were also asked weekly whether or not they agreed with the following statements: “I have been having thoughts of killing myself,” “I have thoughts about how I might kill myself,” and “I have a plan to kill myself.”

At baseline, 37.2% of the participants reported anger attacks within the past six months. Aggressive behaviors were reported by 32.8%. Levels of suicidal ideation were found to be significantly higher in MDD participants with anger attacks than those with MDD with no anger attacks. Specifically, participants who reported experiencing nine or more anger attacks in the previous month reported significantly higher suicidal ideation at baseline than those who reported fewer anger attacks. Participants who reported anger attacks at baseline continued to report higher suicidal ideation while taking antidepressants, the authors reported.

“These associations between anger attacks and [suicidal ideation] were significant even after controlling for related constructs such as irritability and hostility or other features associated with [suicidal ideation] such as depression, anxiety, previous history of suicidal tendencies, pain, and hopelessness. Similar findings were noted for the presence of aggressive behaviors,” Jha and colleagues wrote. “Taken together, these findings suggest that the presence of anger attacks may identify a subgroup of depressed patients with persistently elevated [suicidal ideation].”

For related information, see the Psychiatric News article “The Role of C-L Psychiatrists in Assessing Suicide.”

(Image: iStock/Chinnapong)


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