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

Published online by Cambridge University Press:  06 March 2020

Manish K. Jha ,
Maurizio Fava ,
Abu Minhajuddin ,
Cherise Chin Fatt ,
David Mischoulon ,
Nausheen Wakhlu ,
Joseph M. Trombello ,
Cristina Cusin  and
Madhukar H. Trivedi Open the ORCID record for Madhukar H. Trivedi [Opens in a new window]
Manish K. Jha
Affiliation:
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, USA
Maurizio Fava
Affiliation:
Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
Abu Minhajuddin
Affiliation:
Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, USA
Cherise Chin Fatt
Affiliation:
Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, USA
David Mischoulon
Affiliation:
Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
Nausheen Wakhlu
Affiliation:
Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, USA
Joseph M. Trombello
Affiliation:
Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, USA
Cristina Cusin
Affiliation:
Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
Madhukar H. Trivedi*
Affiliation:
Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, USA
*
Author for correspondence: Madhukar H. Trivedi, E-mail: [email protected]
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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 attacksantidepressant treatmentanxietyirritabilitymajor depressive disorder
Type
Original Articles
Information
Psychological Medicine , Volume 51 , Issue 8 , June 2021 , pp. 1355 - 1363
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Copyright
Copyright © The Author(s) 2020. Published by Cambridge University Press

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