Anger attacks are associated with persistently elevated irritability in MDD: findings from the EMBARC study

Psychol Med. 2021 Jun;51(8):1355-1363. doi: 10.1017/S0033291720000112. Epub 2020 Mar 6.

Abstract

Background: This report tests the association of self-reported symptoms of irritability with overt behavior of anger attacks (uncharacteristic sudden bouts of anger that are disproportionate to situation and associated with autonomic activation).

Methods: Participants of the Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care study who completed Massachusetts General Hospital Anger Attacks questionnaire were included (n = 293). At each visit, the 17-item Hamilton Depression Rating Scale and the 16-item Concise Associated Symptom Tracking scale were used to measure depression, anxiety, and irritability. In those with anger attacks present v. those without anger attacks, separate t tests and mixed model analyses compared afore-mentioned symptoms at baseline and changes with treatment respectively. As anger attacks may occur without aggressive behaviors, analyses were repeated based only on the presence of aggressive behaviors.

Results: At baseline, those with anger attacks (n = 109) v. those without anger attacks (n = 184) had similar levels of depression but higher levels of irritability [effect size (d) = 0.80] and anxiety (d = 0.32). With acute-phase treatment, participants with anger attacks experienced a greater reduction in irritability (p < 0.001) but not in depression (p = 0.813) or anxiety (p = 0.771) as compared to those without anger attacks. Yet, irritability levels at week-8 were higher in those with anger attacks (d = 0.32) than those without anger attacks. Similar results were found in participants with aggressive behaviors.

Conclusions: The presence of anger attacks in outpatients with major depressive disorder may identify a sub-group of patients with persistently elevated irritability.

Keywords: Anger attacks; antidepressant treatment; anxiety; irritability; major depressive disorder.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anger
  • Antidepressive Agents / therapeutic use
  • Depressive Disorder, Major* / drug therapy
  • Humans
  • Irritable Mood

Substances

  • Embarc
  • Antidepressive Agents