Depression can affect mood in a number of ways, including causing irritability. This is sometimes a feature of my own depression, and it can get pretty ugly.
In the DSM-5, adults must have at least one of depressed mood or anhedonia to receive a major depressive disorder or bipolar depression diagnosis, but in children, irritable mood on its own can fulfill the depressed mood criterion. Some researchers have argued irritability should be a core symptom for adults as well as children. It seems that the main argument against this is that irritability is too nonspecific, and including it would risk over-diagnosing people who aren’t actually depressed.
What the research says about irritability
About half of people with major depressive disorder experience irritability as part of their illness. Irritability is associated with more severe depressive episodes and comorbid anxiety disorders. In a study by Fava and colleagues, people who experienced irritability were more likely than those without irritable depression to have experienced a depressive episode that lasted 12 months or more.
While some research has suggested that irritability tends to be an indicator of bipolar rather than unipolar depression, this finding hasn’t been consistent across studies. Irritability may also be part of a depressive episode with mixed features (also known as a mixed episode).
Antidepressant treatment can help with depression-related irritability, and this effect can start showing up only a week after initiating antidepressant treatment.
My own experience
I can get really irritable sometimes during depressive episodes. It’s not something that I experience most of the time when I’m depressed, but when it does show up, it’s vicious. I swear at people, I put them down, and I’m a pretty nasty piece of work. Yet that’s not who I am as a person; it’s a very clear departure from my normal self. It doesn’t help that my more adaptive coping mechanisms tend to go offline the sicker that I get, and my inner 4-year-old starts revelling in her hissy fits. It’s hard to say how much of my depressive irritability is being bothered by things that wouldn’t normally affect me vs. disinhibition leading me to run with irritation that I would normally shrug off; it’s probably some of both.
One of my former psychiatrists told me that I could be “a real bitch” sometimes when I’m sick. He wasn’t trying to criticize; he was just telling it to me straight, and I agreed with him.
I remember one occasion when I was at a restaurant where a friend was performing at an open mic night. One of her other friends, who I only vaguely knew, said something inconsequential that bugged me, and I totally went off on her. It was ugly, and my friend was clearly embarrassed by me, which pissed me off even further.
In the context of hospital
The irritability is particularly likely to come out to play when I’m hospitalized involuntarily and my autonomy is limited. That’s definitely one of the reasons why my hospitalizations have been quite difficult. I think there was only one out of my five hospitalizations when I didn’t swear and more generally flip out at the doctors or nurses, and that was the only one in which I was voluntary for the entire stay. Some of the irritability from my most recent hospitalization was on display in the post A Dickless Prick: A Letter to My Psychiatrist.
I do recognize when I’m irritable and I’m aware that it’s because of the illness, but that doesn’t help me to control it. Mostly, I just try to avoid people when I’m feeling that way, but in hospital, that’s just not an option. On top of that, I’ve generally not been very impressed with how staff have treated me while in hospital, so I’m pretty low on fucks to give about how I treat them.
Recognizing irritability as part of depression
For me, irritability isn’t an early warning sign of the beginnings of a depressive episode; it usually only bubbles up when things are already pretty dire. However, I think it’s useful to recognize that depression can show up as irritation, as it can be a clue that some sort of additional intervention is needed. Because it’s so nonspecific, it can be easy to brush off as being due to circumstances or being a bit sleep-deprived, but for people who already know they have a mood disorder, it’s worth paying attention to.
Do you ever experience irritability as part of your own illness? Are you able to mostly keep a lid on it, or does it sometimes explode outward in other people’s direction?
References
- Balbuena, L., Bowen, R., Baetz, M., & Marwaha, S. (2016). Mood instability and irritability as core symptoms of major depression: An exploration using Rasch analysis. Frontiers in Psychiatry, 7, 174.
- Fava, M., Hwang, I., Rush, A. J., Sampson, N., Walters, E. E., & Kessler, R. C. (2010). The importance of irritability as a symptom of major depressive disorder: Results from the National Comorbidity Survey Replication. Molecular Psychiatry, 15(8), 856-867.
- Jha, M. K., Minhajuddin, A., South, C., Rush, A. J., & Trivedi, M. H. (2019). Irritability and its clinical utility in major depressive disorder: Prediction of individual-level acute-phase outcomes using early changes in irritability and depression severity. American Journal of Psychiatry, 176(5), 358-366.
- Verhoeven, F. E., Booij, L., Van der Wee, N. J., Penninx, B. W., & Van der Does, A. J. (2011). Clinical and physiological correlates of irritability in depression: Results from the Netherlands study of depression and anxiety. Depression Research and Treatment, 2011.
Managing the Depression Puzzle takes a holistic look at the different potential pieces that might fit into your unique depression puzzle.
I get irritable in all phases of my bipolar – depressed, mixed, manic. It’s actually over if the guest things to show up and had become a good indicator that an episode is coming fast. I hate it. I say and do things that I euros never say or do otherwise, and I have a hair trigger. I generally try to lay low as much as possible and limit my interactions with pretty much everyone.
It’s a shitty place to be.
I recently had someone go off on me, over something extremely petty. I was polite about the ordeal, didn’t say anything wrong but she flipped her shit. All because I called the prime minister “Turdeau” instead of Trudeau. I can’t stand him and she’s a leftist but that’s besides the point. Clearly I offended her, so I apologized 3 TIMES. We were friends for over a year, would message each other daily, but apparently that all means nothing because it took her 2 seconds to block me.
She deleted our entire conversation on Telegram, didn’t say goodbye in the chat, didn’t try to reason with me or come to an agreement. No, she blocked me on every platform she knew I was on including Medium. She even blocked me on IG even though I haven’t used IG since 2019. She proceeded to send me a nasty email the following day which I didn’t acknowledge, because why would I? I didn’t deserve her mistreatment. She used to frequent my blog and left 71 comments on my blog, but I’m sure she blocked me on WP too. I wouldn’t be surprised if she had some unaddressed mental health issues including depression and resting bitch face. 🙄 shit like this can be prevented if people learned how to address their problems like adults rather than bottle everything inside, never say a damn thing, and then explode over something stupid.
Oh that’s really unfortunate.
Yes, it really is. It still bothers me a lot.
Great post. Irritability is a big part of anxiety too. Since I have anxiety spells that crash into depression, mean Bitch Johnzelle makes his appearances often.
That sucks.
Irritability is a big part of my own mental health journey. Especially around my cycle due to having hormonal imbalance. I’ve told my husband to just tell me when I’m being a bitch and just go the opposite way. It’s so hard to control sometimes. It’s almost like I can feel the irritation on my skin. Most days I’m pretty laid back and calm, but man when I become irritable it’s almost like I’m a different person. When I was in a facility as a teen one staff member would ask me if she was getting Crystal or “Elizabeth” that day. Elizabeth is the name she came up with after noticing the drastic changes in me. If I flicked her off, she just let me be and didn’t take it personally. One of the best staff members ever.
That’s pretty cool that she was able to recognize that.
Totally agree with the hormone imbalance aspect. As a guy who requires TRT, in the last few days before the monthly shot I’m cranky as hell and prone to grey sky thinking. Bring on the T, already!
Out of whack hormones can definitely do a number on mental health.
I have indeed experienced irritability as one of my main symptoms in the past during years when I was on and off in a depressive episode. I was irritable to the point it felt extreme and even when family around me would tell me how I was acting was unacceptable, I felt justified in my rage and even more so because i understood I was struggling due to mental unwellness but they just thought I was in a shit mood from lack of sleep or whatever. This was further complicated by my reluctance to talk about how I felt because the norms of the culture my family tried to bestow on me had a complete lack of awareness about mental health and/or how to help someone who might be struggling mentally. I would say getting a proper diagnosis on my own through a nurse practitioner (apparently I had/have persistent depressive disorder), starting meds and therapy, and getting more real life exposure to combat my social anxiety has greatly improved my quality of life and how I interact with other people without going off the rails. However, it can still be a struggle in so many ways. I still find myself having trouble with holding in my irritation and not being ticked off enough to want to lose my temper at the nearest person to me over a minuscule thing during times when I am not in a talkative mood and just want to be left alone. It’s hard because the irritation tends to mount from a combination of feeling depressed and hopeless and also very anxious about whatever I am stressed out about, which in turn makes me want to lash out when someone tries to verbally engage with me and I don’t want any part of it.
Needing to be left alone is big for me too.
Yes, I really lean on this coping mechanism. I’m unsure if that’s a good or bad thing.
I guess it depends what you do with that time. It can be positive or negative. I spend a lot of time alone. At first it wasn’t by choice, and it was hard. Now when it’s by choice, I journal, dance, write and do things that fulfil my passions. If I’m strong enough at the time, that is.
I think balance is probably important too. Going full-on hermit probably isn’t the healthiest, as tempting as it…
100%
Yes. I went untreated for years because I had no idea irritability was a symptom of depression.
Oh that sucks.
Yeah…
I get irritable too sometimes when my depression is bad!
I’m hard to be around then!
I bet Nitro still loves to be around you even if you’re irritable. ❤️
Yes he still loves to be around me 💖💖
Excellent. Thanks for this. Definitely relatable with my bipolar and it’s difficult when attempting any explanation for it, let alone maintaining a job with a fully focused mood (adhd bites at the best of times too)
Thanks for the share, the world needs more posts like these.
❤️
My current depressive/mixed episode has left me essentially mute and highly irritable. My poor dog is an active breed and as such needs daily off-leash exercise, which we need to drive 20 mins to reach. I only recently became aware that my irritability is escalating my ‘normal’ mid-range road rage to dangerous levels. So.. i have been rationing my trips up the road. Hope it ends soon.
That sounds really tough.
I used to be really irritable and it wasn’t helped by being forced to hide it. I didn’t take it out on anyone, but I couldn’t even get uninterrupted alone time to handle it. It definitely worsened my irritability because all of my family members could be ridiculously irritable and take it out on each other or (often!) me… but I couldn’t even have alone time to privately deal with my irritability. Obviously, I couldn’t seem irritable around them or shit would happen.
Then yeah, you know what happened with C… Apparently valid irritation at repeated boundary violations isn’t allowed lmao.
Now that I’m away from all that… I still suffer from depression and anxiety, but I’m not so irritable because I’ve space to myself.
I’m so glad you’re out of that disaster situation with C.
Definitely agree!
With my bipolar illness I am often irritable first thing in the morning for about a half hour before my morning coffee kicks in. Anxiety is often worst first thing in the morning as well. Thankfully the irritability does not appear to continue throughout the day. Provided I am able to accurately assess my moods……. 🙂
I’m glad the morning coffee helps.
You wrote this 4 days after my disability hearing in which the “expert” said, “Well, anyone can get irritated,” when dismissing any importance assigned to irritability. I have experienced more irritability in the past two years than ever before. Previously, it wasn’t a symptom, but it certainly is now. Fortunately your therapist didn’t react to your ‘bitch’ mode by raising his voice and being offended. Typically, I bottle it up, which is not healthy.
That “expert” doesn’t have a clue. Whether it explodes outwards or gets bottled up inside, depressive irritability does so much damage. For an “expert” to not recognize that, they can’t possibly be treating actual people with actual depression.
She’s a psychiatrist and I think she’s a professor rather than a clinician. *sigh*
Ugh
Thank you SO much for this entry. I was literally just talking to my therapist about this topic last week, and have been in and out of writing a future entry myself on it. I’m so glad you brought up anger and agitation in relation to moods. I have a new mood tracker called “Daylio” and it’s epic. I can breakdown the data to have it show when my frustration and anger levels are through the roof and it is directly linked to my depression. It’s helping me realize when I get as horribly down as I do, I lash out at myself and whoever is around me feels and hears my negativity. I also, have been rightfully labeled as a “bitch” due to my anger levels. Thank you for this post!!
I use a bullet journal to track my moods. I spend most of my time alone, so there aren’t usually consequences to my irritability, but when it’s bad I even get pissed off at my little guinea pgis.
I honestly thought mood trackers were absolute bullshit until I plugged in all the information I had on myself. But, I’m so grateful to be wrong on that. Oh, tell me about it! My anger used to control me. The older I get, and the further I continue to attempt to distance myself from actually lashing out, the more I realize how much it has actually affected me over the years.
I find that just giving my mood a numerical rating isn’t that helpful, because what counts as a certain rating today might be quite different from what I used the same rating for a month ago. It works better for me when I include more details about specific emotions I’m feeling and other factors like whether or not I’m sleeping okay.
Right! I totally agree. The app I use now, I can put in multiple moods – that I can edit and create more of, throughout the day, and I can also customize my activities and make as many as I want. Then I can see graphs or charts of what activity was with what mood.. or see what I do on days I feel “good” vs things I do on days when I’m “agitated” or “depressed”.. the whole process of documenting where I’m at is fascinating. I can see mood changes with medication changes and a whole bunch of different things.. I get very specific too and note things throughout the day. I really, really love your entries. Thank you for writing! 🙂
Thank you! 😊
You’re ever so welcome! 🙂
I have anxiety and depression, so I’m not sure which one my irritability steps from. I do have general irritability that turns explosive when I’m not able to rest or get enough me time
Will it be easier to get some you time when your son is back at school?
Yes, definitely! However, due to high gas prices, they might make school only 3 times a week 😩
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