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.
My mum would have snappy moods. I remember a time in my teens when for nearly 3 months I felt like I was walking on egg shells. I knew something wasn’t right by third month in and so one occasion when she snapped, and said to my mum sharply “what the fuck is wrong with you?” Then I went on to explain my observations just mentioned here, saying I know this isn’t you and something not right, but I am having no more of it. It turned out mum had stopped her night meds. So I soon got that one sorted.
Mum can be moody. But not to the extreme like that unless something is seriously wrong.
Myself, I am mainly quiet. But if I become a bitch, I am a bitch towards myself. I am my own worst enemy.
The only time I have shown outwardly, but not snapped at anyone, but just showing my own upsetness was not long back at work as you know. Not helped by tiredness. Tiredness is the trigger for me than can show my moods outwardly at some point at times, if its going to happen. I am mostly quiet about it for some time and ut can sometimes mount up. But with me doing my mediation on top of other things, that helps a lot. But its not at the stage to quite stop my outwardly outburst, should it happen.
Tiredness definitely makes self-control hard.
That must have been very difficutl with your mom when you were younger. It’s good that by calling her out you were able to get to the root of what was going on.
When I snapped like that, that day, that was my build up of keeping quiet until that point.
I expected mum snapping back immediately after before me getting to explain in a calm manner to her. But she actually stayed quiet to lusten and dpoke appropriately back, explaining what was wrong. We then sorted it together.
That’s good.
I definitely think I get irritable, but I try and listen to my partner in those moments. I can get nasty too, but again, I try and listen to a voice of reason. It doesn’t always work though!
That and I don’t know how long the nastiness often lasts. I haven’t even got a clue unfortunately.
That voice of reason can be awfully quiet sometimes!
I understand. This shit sucks.
Yup.
This piece is very timely. I literally just finished a session with my therapist where I discussed the constant anxiety mixed into my bipolar depression episodes. But, this time, for a little extra flavor, I’m kind of manic too. I’m a bitch on wheels and there are no two ways about it. Last night I put dinner on the table, threw down plates for hubby and MIL and then went to bed. I was so aggravated by all those invisible pokes anxiety and mania were giving me that I didn’t even want to eat, and I certainly didn’t want to be around people. Luckily hubby has learned to listen to me when I’m like this and the only resistance he puts up is to say “Did I do anything wrong?”. Poor thing. But he’s learned to get out of my way and let me do what I need to. If that means leaving me alone, then so be it.
That’s good that he’s figured out how to handle it. Sometimes I feel like I should really be shipped off to a deserted island where no one can get in my way.
lol I hear that. I lost it on my MIL once because she put the glass in the dishwasher and didn’t follow my prescribed OCD rules. Poor woman.
Lol
I’ve had anger issues my whole life, but I haven’t noticed them being worse during a depression or right before. Generally my depression causes blunting of all emotions…
That’s a yucky feeling.
Too funny. I’m actually writing something similar. I can definitely be a bitch, though I mostly hold it in (which creates its own set of problems).
Yeah, pretty much a no-win either way.
It’s definitely not sexism, though 🙄
Haha
Yeah, don’t hold it in. There’s healthier ways to let go of the anger.
I think I have low-level irritability when depressed which mostly manifests as snapping at my parents and being sarcastic. Maybe I shouldn’t try to blame that on depression. I don’t generally get really angry with people, even when depressed.
Some of my irritability is probably not depression or any other mental health issue, but just a consequence of someone pushing forty still having to live with his parents, and the very big personality differences between my parents and me making it not always possible for us to get along in a frictionless way.
I think if I were to try moving back in with my parents, by the end of the first week, either they’d be kicking me out or I’d be running away screaming.
We originally started therapy 8 years ago for anger and irritability. We get irritable daily. Living with people contributes highly, though we get stressed, irritable, scared, etc., alone, too.
Not being able to be alone in hospital is one of the key reasons we haven’t gone in a few years. Need. Space.
I don’t think I could handle living with anyone other than the guinea pigs. Spave is as important as oxygen.
Do you ever experience irritability as part of your own illness? Oh yeah. In fact it was a full part of the whole mental illness scenario in my case. Problem was I ‘stuffed’ it and never did express nor explode, but the havoc was massive all the same. Made my BPD worse.
Are you able to mostly keep a lid on it, or does it sometimes explode outward in other people’s direction? For most of my life, as mentioned above, I’d ‘stuff’ the irritation down deep. I watched my father do that many times, and his always resulted in an inevitable explosion where he’d turn his anger on objects and obviously inward.
My mother, the polar opposite of Pops, never left anyone in any doubt whatever when she was irritated. And since she was irritable most of the time, being around her was like walking through a minefield. Even careful steps might result in an explosion.
Neither of these ways of coping is healthy. I’ve done massive amounts of work to correct what I see as a flaw. I still have trouble distinguishing what is an honestly angry response for a good reason, and me being irritable. My biggest step toward healing has been that I’m no longer afraid of what will happen if I do express anger or irritability – I found my voice and a measure of freedom from being so irritable by being aware that I have a choice. And that I can defend myself come down to it.
It strikes me that not being heard is a huge piece of why irritability can get out of control. Having others tell you what you have to do, say and think, would irritate the shit out of me, so your reaction to that enforced committal is perfectly understandable. You weren’t heard. .
That’s a very good point. Having a voice and being able to use it is such a powerful thing.
I really appreciate what you say about awareness not helping you control irritability. It helps me with self-compassion for my own irritability and anxiety. Thanks 🙂
😊💕
I’m really glad you wrote this post. I have a strong aversion to displays of anger having grown up in a yell-y setting and this helps to reframe some of it.
It’s weird, I normally have a pretty strong aversion to it too, as my dad would have angry flip-outs when I was a kid. I think what I do is more temper tantrum-ish than aggressive.
I also get irritable when my depression is already bad, and it’s one of the more uncomfortable symptoms for me because it deviates so far from my normal self. I usually explode at inanimate objects that are not cooperating with me and the world at large when I make a mistake. And then I feel so guilty about being angry (working on accepting my negative feelings, lol) that I just cry and cry. Of course, it turns out I have also have PMDD, so when that and the depression overlap… hoo, boy.
Oh that sounds messy…
Great post. I just realized that I had been in that loop for awhile, so I’ve gone back to some basics which has helped.
Good to hear.
Ah shit! When irritability strikes, everyone near me has learned to duck. I do have a mood disorder that was first diagnosed as major depressive disorder. I have gotten it under control with medication but I, like you, can be a real bitch when it flares.
Definitely not fun.
💕
I definitely have a lot of bitchiness, but I see them as somewhat separate from feeling depressed. It’s almost like the bitchy side can be at times a mask for the depression, but when I’m really really depressed, I don’t even have it in me to be a bitch.
That makes sense.