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?
- 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.