Patients who have depression and frequently experience bouts of anger may have an increased risk of developing bipolar disorder, a study in Depression & Anxiety has found. The study also found a link between aggression reactivity—aggressive behavior in response to feeling threatened, provoked, or frustrated—and conversion to bipolar disorder.
Rahele Mesbah, M.Sc., of Leiden University Medical Center in Leiden, The Netherlands, and colleagues analyzed data from 1,585 people with depression who participated in the Netherlands Study of Depression and Anxiety (NSDA), a longitudinal study of adults aged 18 to 65 years. Four years into their participation, people in the NSDA completed questionnaires about trait anger (tendency toward anger as a personality trait), aggression reactivity, anger attacks, and personality traits associated with greater amounts of anger. NSDA participants were also evaluated using the Composite International Diagnostic Interview at two, four, six, and nine years of follow-up.
At the end of four years, 77 people converted to bipolar disorder, 349 had current depressive disorder, and 1,159 had remitted depressive disorder. Those who converted to bipolar disorder had the highest levels of trait anger and aggression reactivity. They also had the greatest prevalence of anger attacks, antisocial personality traits, and borderline personality traits.
In a separate analysis, this time including 1,744 people with depression in the NSDA who had nine years of follow-up, the researchers found that aggression reactivity predicted incident hypomania and thus conversion to bipolar disorder.
“Feelings of anger might be an important target for early recognition of illness and intervention in BD [bipolar disorder],” Mesbah and colleagues wrote. “Increased feelings of anger in unipolar patients in combination with some other known clinical characteristics, such as multiple brief depressed episodes, a lack of response to antidepressants, [or] a family history of [bipolar disorder] might help to signal an upcoming conversion to [bipolar disorder].”
For related information, see the American Journal of Psychiatry article “Early Intervention in Bipolar Disorder.”
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