The Most Overlooked Symptom of Depression

[00:00:00]Have you ever been so depressed that it pissed you off? Like you're sad, but the fact that you aren't enjoying things and are feeling down just makes you mad at everyone and everything. A couple of weeks ago, I shared a clip about this from my podcast. And apparently a lot of you know exactly what I'm talking about because that clip was seen over 5 million times in just 2 days. But underneath all of those views, there's a harder question and it's the one I actually want to answer today. If you're angry all the time, are you depressed?

[00:00:30]Or are you just an angry person? Because I know some of you are scared. It's the second one. You've maybe spent years hearing that you're difficult or short-tempered or hard to live with.

[00:00:40]Maybe you started to believe it. So today, we're going to actually figure out how to tell the difference. We'll talk about what irritable depression is, why anger and depression live so close together in the brain, why it gets missed in men and teenagers more than anyone else, and how to tell depressive anger apart from grief. And at the end, I'll tell you what to do if you recognize yourself in this. Now, before we dive in, I want to be fair to the skeptics because I can already see the comments coming in. Some of you are thinking, "Great, now being a jerk is a mental health condition. Another excuse." And honestly, I get it.

[00:01:13]snapping at your partner hurts them whether or not there's a diagnosis underneath it. A diagnosis explains behavior. It doesn't erase the impact.

[00:01:21]And yes, some people really do just run hot. That's temperament and it's real.

[00:01:27]And we're going to talk about how to tell that apart from depression later in this video, so hang around. But here's what the research actually shows. And this number surprised even me. According to multiple large studies, including work published in molecular psychology and psych [sighs] [gasps] [clears throat] Okay, but here's what the research actually shows. And this number surprised even me. According to multiple large studies including work published in uh molecular psychiatry and jamma psychiatry irritability shows up in roughly 40 to 50% of people during a major depressive episode. So this isn't a fringe presentation of depression. For a huge number of people anger and irritability are the presentation and we almost never talk about it. When most of us picture depression we picture Eeyore.

[00:02:22]love Eeyore, but he's sad, slow, gray, low energy, tail, you know, dragging in the mud. And like I said, don't get me wrong, I love Eeyore. He's one of my favorite characters, but he's also the reason so many of us overlook our symptoms of depression for so long.

[00:02:38]Depression's diagnostic criteria actually includes irritability as a recognized symptom alongside sadness and low mood. It's right there in the DSM.

[00:02:48]But for whatever reason, when we talk about depression in movies or on social media or even on television, that's not what gets shown. We only see people who are sad, bedrotting, and not talking to anyone. So, most of us don't even think about anger or irritability as being part of depression at all. But depression can look like snapping at your partner over something tiny, like how they loaded the dishwasher, a low simmer of rage at your co-workers for no clear reason, getting into it with a stranger in a parking lot over a space that you both wanted, or in my case, it can feel like having the most angry and nasty voice inside your head all day, every day. None of that screams depressed to the person experiencing it.

[00:03:33]It honestly, it just feels like being a jerk or being stressed or being tired.

[00:03:38]So, we don't get help because we don't think irritability is something that we should get help for. So, why do anger and depression live so close together?

[00:03:48]Well, there are two layers to this, a brain layer and a learning layer. So, let's talk about the brain layer first.

[00:03:54]Now, depression involves changes in serotonin and dopamine regulation. And those are the same systems involved in impulse control and mood stability. When they're disregulated, your threshold for frustration drops it. Think of it like running low on resilience. Things you could normally just shrug off suddenly feel too intense to let go of and you lash out. But the learning layer is where this really gets interesting to me. And it comes down to a concept in psychology called primary and secondary emotions. And we've touched on these before, but it's especially important to understand here. A primary emotion is your immediate like gut level response to something like sadness when you lose something or fear when you feel threatened. A secondary emotion like anger often develops as a reaction to that first feeling.

[00:04:47]Sadness shows up, right? And then anger comes in right behind it to take over and protect you from that initial feeling. And it happens so fast that we don't even notice it. Because anger works like armor. Sadness and fear, they leave us feeling vulnerable and out of control.

[00:05:05]Anger provides a surge of energy and a sense of being in charge. Sadness can feel like sinking. Anger can feel like doing something. And there's also a part of this that gets set up way earlier than we realize. The researcher John Gottman, got to love Gottman, studied this directly in families. And he found that some parents respond to a kid's sadness or fear by helping them sit with it and work through it. Amazing, right?

[00:05:34]Others, other parents respond by minimizing it, brushing it off, treating the emotion itself like it's the problem, like telling a sad kid to just move on instead of naming what they're feeling. Kids from that second kind of home, the ones that brushed it off, still feel all the sadness and fear that any other kid does. They just learn that it isn't safe to show it. So, what they do is then they find a substitute that is accepted. And in a lot of families, especially for boys, that substitute is anger. Which brings us back to depression. Okay? If your system already has a well-worn path from vulnerable feelings straight to anger, depression doesn't have to carve a new route. It just runs a pattern that's already there. Your depression like gets on the freeway, and the exit to anger is the one it knows best, and it's freshly paved.

[00:06:31]I've talked before about losing my dad, but what I haven't talked about as much is what that grief actually felt like in my body, which I have to be honest was mostly rage. And I will never forget yelling at the people at the funeral home when my mom and I went to finalize all the details.

[00:06:49]I legitimately yelled at them and told them they should be ashamed of themselves for profiting off of other people's losses. And it wasn't my finest moment, but I have to say I do still stand by what I said. But the grief that I felt, it wasn't sad in like a quiet way. It wasn't in a weepy way that we'd often expect, you know, grief to look and feel like. I was furious.

[00:07:14]That's the truth. That's how I felt. I was furious that he wasn't going to be there for all the things in my life. I was furious at the people who still had their dads and didn't seem to appreciate it. I was furious that the world seemed to just hum along like nothing had happened. I remember wanting to scream in my car like, "Don't you know that my dad just died? My world had stopped."

[00:07:33]And I if for some reason some part of me just felt like everyone else's should stop, too.

[00:07:40]During this time, while I was in graduate school and I was working two jobs, kind of busy busy lady, I'd frequently get drunk on weekends and end up irrationally angry at anyone and everyone. And I'm not proud of that. In fact, it's one of my most shameful times even saying I'm like, "Right." But I do think it's important to share it here because I know I'm not the only one who's done something like that. And we learned from Bnee Brown that vulnerability is what roots out shame. So, here we are. I hope you can maybe that helps you understand what you've done as well because you're not alone. But through years of therapy, very important, I realized that what was happening is I was angry all the time because anger felt protective. Sadness or the the grief I was experiencing made me feel exposed like I was showing my soft underbelly kind of. It's like anger let me put my spines out instead, you know, like puffer fishing. It's protective. So, even though what I actually felt underneath was grief and sadness, anger was the emotion that got to come out because it felt safer. I went through a more recent depressive episode, too, and one that had nothing to do with grief. I mean, maybe it did.

[00:08:51]I don't It's been a while since we've lost anybody, so I don't think it was anything to do with grief. I just noticed that I stopped enjoying things I used to love. Okay. And I was also down most days. So, I'm kind of like checking those symptom boxes, but the way that it showed up again, anger, including anger at myself for being sad in the first place, which sounds strange, like even saying it out loud to you, but it's like I was so pissed off that I felt bad. It was It's terrible. And the more I tried to do the things that I knew would help, the angrier I got that I even had to try so hard. I was like, "Get it together, Katie. Jeez Louise." You know, and I think part of that came from being a people pleaser, too, because being angry with myself felt safer than being angry at anyone else or at circumstances or at life. It just like I could handle turning it inward, turning it outward to other people. It just felt like too much of a risk to me. And I'm telling you like both of these examples because irrit irritable depression itself can show up in more than one context.

[00:09:57]Sometimes it can be tangled up with loss, like when I lost my dad. Sometimes it just shows up on its own with no clear trigger at all, like my last experience. And if any of this resonates with you, it it doesn't really matter the cause. I want you to know that. What matters is that we recognize it and that we know that we aren't alone in it, cuz I'm right here with you. Okay?

[00:10:17]Irritable depression tends to get missed most often in two groups. I mentioned these a little bit earlier if you caught it. men and adolescents.

[00:10:26]And research published in Jamama Psychiatry by Martin Neighbors and Griffith, very important people, I guess. They found that men are significantly more likely to report symptoms like irritability, anger attacks, and reckless behavior as part of their depression rather than like the sadness or hopelessness more commonly reported by women. I guess I'm an outlier, right? That's how I feel it, too. And when those male typical symptoms are factored into the diagnosis, that well-known gender gap where we say that women experience it more, so that gender gap in depression rates nearly disappears.

[00:11:03]It blew my mind. Which means that the gap may have less to do with how often men experience depression and more to do with which symptoms were asking about.

[00:11:14]So a man experiencing depression is far more likely to get labeled as difficult or he just has a temper than to be identified as depressed by himself or by the people around him.

[00:11:27]Now adolescents run into a similar problem kind of from a different angle I guess cuz irritability is actually listed as an acceptable substitute for that one symptom depressed mood. So it's a big piece of the diagnosis for them, not just a subcategory like for adults.

[00:11:45]So even in children, they say that irritability can be substitute for depressed mood in the DSM for children and teens. And this is specifically because clinicians have long recognized that depression in young people often looks like anger instead of sadness. But big butt here. In practice, an irrational, snappy, and oppositional teenager probably gets sent to the principal's office or gets a label like oppositional defiant disorder or OD long before anyone asks whether depression might be driving their behavior. And in both cases, the men and adolescence, the anger becomes the identity. We often say like he's just an angry person or she's just a difficult teenager. and the actual depression ends up going untreated because nobody's looking for it. So, how do you actually know if what you're experiencing is depression or grief or just who you are? Let me try to lay out the differences. Grief related anger tends to have a clear object like you're angry at the loss itself, at the unfairness of it, at the person for leaving even though they didn't choose to. I felt that way about my dad. It was like how dare you leave me, right? And it also tends to move. It it has like waves. Some days they're sharp. Some days it's quiet or non-existent. And over time, even if it never fully disappears, I don't actually believe the grief fully disappears, but even if it never does, the intensity itself shifts.

[00:13:15]It just kind of lessens to like a more manageable level.

[00:13:20]Now, irritable depression tends to be more diffuse, like there's no particular object. It's baseline anger that gets triggered by whatever's closest. So, like, I'm pissed about the dishwasher, the traffic, my partner's tone of voice.

[00:13:36]It doesn't have that wave pattern that grief has. It tends to persist. It's like palpable. It's everywhere. It's like day after day, regardless of what's actually happening around me, right? And personally, my irritable depression just feels like constant agitation. Like everything is pissing me off. I'm pissing me off. My bad mood is pissing me off. Like I'm angry that I'm even angry.

[00:13:59]Temperamental anger tends to be more stable and consistent across your whole life rather than representing a shift from how you used to be. Okay? So if anger has it's like your anger has always run hot. You're always you always remember yourselves being an angry person. It shows up across every situation in your life whether it's work, school, family, whatever.

[00:14:22]And it doesn't come with the other markers of depression like appetite changes, sleep disruption, loss of interest in things you used to enjoy, then that's more likely temperament than depression. So, more like kind of who you are a little bit, your temperament that rather than depression. And I just I want to say this because temperamental anger is real. Some people are just angry and some people like run hot, you know, their entire lives. And that's personality. And personality is workable. I don't want anybody to think that it's not workable, but it isn't depression.

[00:14:55]What I'll say as a therapist though, because I can't help myself, is that when someone tells me they've always been angry, I'm always super curious.

[00:15:02]Like if they're in my office and they say like, "I've always been like this."

[00:15:07]It often turns out to have a starting point. Like sometimes it really is temperament. I personally haven't seen it, but I know it exists. And sometimes it's a very old pattern that was learned so early that it just feels like who you are. Almost like you just don't remember another time because it was so long ago.

[00:15:23]Okay. And I feel like that difference really matters and it's kind of worth exploring with a professional rather than trying to decide it on your own.

[00:15:30]Okay, if you're still wondering, ask yourself this. Has something changed?

[00:15:38]If you used to have a longer fuse and you don't anymore, think about it. If things that never used to bother you are suddenly unbearable, that's how I feel.

[00:15:48]if you're more exhausted or sad underneath that anger or if there have been significant life changes recently.

[00:15:56]Those are all important things to bring up with your doctor or therapist. And when I was even putting this together this video, I was thinking that I recognized the anger in myself because even when I would get angry with people like even Sean or a friend or just with I'd want to cry and I was like, "Oh, it's so frustrating cuz I'm angry." But I think it's because under that anger is actually sadness. It's actually hurt.

[00:16:19]It's actually something else. Again, that secondary emotion. So, just consider, pay attention, and then, you know, bring it up with your therapist.

[00:16:27]If everything we've talked about resonates with how you feel, let's get into what we can do about it. Okay.

[00:16:32]First, track the pattern for 2 weeks before drawing any conclusions. Write down when the irritability shows up, what's happening around it, and how long it lasts. Irritable depression tends to reveal itself as a pattern once you can see it laid out. Even if it feels completely random dayto day. So let's track it. Okay.

[00:16:54]Second, when you do talk to a professional, bring up the irritability specifically, not just the sadness. A lot of people walk into the first therapy or doctor's appointment and only describe the parts of their depression that match the E your stereotype because like that's the only version that we've been taught counts.

[00:17:13]Talk about all of your emotional changes. Let them know how you feel angry more than you used to. That you're snapping at people you love. All of that matters just as much as the sadness or lethargy do. If you're a parent of a teenager, just have to throw this in here, who seems constantly irritable.

[00:17:30]Consider depression as a possibility alongside the other behavioral explanations. And it can help to ask directly. Teenagers don't always volunteer things. They might not want to say to you, "Mom, I think I might be depressed." But they'll often answer honestly if someone asks. So check in with them and take your time. Know that this can most likely come out of a few conversations over a period of time rather than just one. So let them decide to open up to you. This isn't something that we can really force. And if you've been feeling bad about yourself because of this, because you're the person who snaps, who's hard to be around, who doesn't match what depression is supposed to look like, irritability is a recognized real presentation of major depressive disorder. It is a symptom and symptoms are treatable. This has nothing to do with your personality or with being just who you are. Trust me, I've been there and it does get better. If you spent years thinking you were just a hard person to live with or just short-tempered or just difficult, I want you to consider that there might be something else going on. The question I asked at the start of this video, am I depressed or am I just an angry person has an answer? It's findable. We can figure it out, right? We just have have to actually ask it out loud to someone who can help us figure it out. For a lot of us, anger is depression's loudest voice. And once you know that, you can actually do something about it. Let me know in the comments if this resonated and if you've experienced this yourself.

[00:19:03]Thank you so much for watching. Have a wonderful week and I'll see you next time.