I want you to stop for a minute and picture in your minds eye what it looks like when you see an article about depression, in a magazine, online, or even on television?
I bet I can guess what’s in your head, because it’s the same thing that pops into most of our heads.
A lone woman, sitting, or laying down, in a large, but empty space. It might even be shot in black and white, but she is definitely alone, definitely sad-looking, and more than likely, white.
That is what we’ve been told depression looks like. So, when we talk about men or people of color, or other groups being depressed, we typically look for them to act like the woman in that picture. But they aren’t the woman in that picture, so why would we expect their depression to look that way? Any one of us might just display some different symptoms.
Consider, if you will, that irritability and anger are just as valid symptoms of depression, even though we don’t seem to picture it that way.
If you pick up what is often called the “bible of psychiatry,” the Diagnostic and Statistical Manual of Mental Disorders, you’ll find that the list of core symptoms for major depression doesn’t include anger.
“It’s not included at all in the adult classification of depression,” says Dr. Maurizio Fava, a psychiatrist at Massachusetts General Hospital and a professor at Harvard Medical School.
But he points out that irritability — a reduced control over one’s temper that results in angry outbursts — is listed as a core symptom of depression for children and adolescents. It has never made sense to him that it’s not included for adults. “Why would someone who happens to be irritable and angry when depressed as an adolescent suddenly stop being angry at age 18?” he asks.
Dr. Fava’s question is valid. As an angry and sullen teenage boy, I was suffering from depression. I have no doubt about that, even if I didn’t have an official diagnosis at the time. When I turned 18 it didn’t somehow morph into a non-angry version. I was still angry. And, even now one of the first signs that I need to think about whether my depression might be creeping back is that I’m irritable all the time. Not that I stay in bed. (Though that is possible for me too)
The fear, of course, is that by not understanding that anger and irritability might = depression, we are not getting people help who need it.
Research has shown anger is associated with “greater symptom severity and worse treatment response” when it’s part of a mental health condition like depression. That’s why Strongin encourages anyone who is feeling angrier than usual to reach out for help instead of brushing it off.