[Anger outbursts in unipolar depressive disorders]

Approximately one third of depressed outpatients present with "anger attacks", sudden spells of anger accompanied by symptoms of autonomic activation such as tachycardia, sweating, flushing, and tightness of the chest. These anger attacks are experienced by the patients as uncharacteristic of them and inappropriate to the situations in which they occur. Depressed patients with anger attacks are significantly more anxious and hostile, and they are more likely to meet criteria for borderline, histrionic, narcissistic, and antisocial personality disorders than depressed patients without anger attacks. Treatment studies suggest that antidepressant treatment of anger attacks in depression is helpful and sage. Anger attacks disappear in 53-71% of depressed outpatients treated with antidepressants such as fluoxetine (Prozac), sertraline and imipramine. In addition, the rate of emergence of anger attacks after treatment with fluoxetine (Prozac) (6-7%) is no different from the rates observed after treatment with sertraline (8%) and imipramine (10%), and lower than the rate with placebo (20%). Finally, one can hypothesize that antidepressants that affect serotonergic neurotransmission, known to be involved in the modulation of aggressive behavior in animals and humans, should be particularly effective in this population. Larger placebo-controlled studies, comparing selective serotonin reuptake inhibitors such as fluoxetine with relatively noradrenergic tricyclic antidepressants such as desipramine, may help us understand whether depressed patients with anger attacks show a distinctive responsiveness to drug treatment.