Magazine article Clinical Psychiatry News

Anger Attacks More Common in Bipolar Than Unipolar Depression. (Associated with Earlier Onset)

Magazine article Clinical Psychiatry News

Anger Attacks More Common in Bipolar Than Unipolar Depression. (Associated with Earlier Onset)

Article excerpt

PHILADELPHIA -- Anger attacks, which have been described in patients with major depressive disorder, are apparently even more prevalent in bipolar depression, Dr. Roy H. Perlis said at the annual meeting of the American Psychiatric Association.

Earlier studies have suggested that 40%-45% of patients with major depressive disorder (MDD) experience episodes of sudden, inappropriate anger accompanied by signs of physiologic arousal as sweating and trembling. "It looks like panic, but with rage instead of fear," said Dr. Perlis of Massachusetts General Hospital, Boston.

The prevalence is lower in atypical depression (35%) and dysthymia (25%-30%), and has been quite rare (0%-5%) in controls.

Challenge tests, such as a prolactin rise in response to a serotonin stimulating agent, suggest an association between anger attacks and serotonergic dysfunction, and they are 50%-75% likely to respond to treatment with selective serotonin reuptake inhibitors (SSRIs).

Anger attacks are associated with treatment nonadherence and with a heightened risk of violence. In one sample of 56 individuals, 60% reported attacking others physically or verbally.

Dr. Perlis reported a study of 114 depressed outpatients with bipolar I or II disorder and 121 with unipolar depression. …

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