Anger attacks in depression

Anger, hostility and irritability are frequently observed among patients with 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, hot flashes, and tightness of the chest. Depressed patients with anger attacks are significantly more anxious and hostile and they are more likely to meet criteria for avoidant, dependent, borderline, narcissistic, and antisocial personality disorders than depressed patients without anger attacks. Several studies suggest that antidepressant treatment of anger attacks in depression is safe and effective. Anger attacks disappear in 53-71% of depressed outpatients treated with antidepressants such as fluoxetine, sertraline, and imipramine. In addition, the rate of emergence of anger attacks after treatment with fluoxetine (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, since the central serotonergic neurotransmitter system is known to be involved in the modulation of aggressive behavior in animals and humans, one can hypothesize that antidepressants which affect this system may be particularly effective in depressed patients with anger attacks.