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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Phillipa on September 13, 2013, at 20:55:52
Not bipolar a new subtype of Depression. Phillipa
Medscape Medical News > PsychiatryIrritability, Anger Indicators of Complex, Severe Depression
Megan Brooks
Sep 12, 2013
Symptoms of irritability and anger during a major depressive episode (MDE) appear to be clinical markers for a significantly more complex, chronic, and severe form of major depressive disorder, a new study indicates.Results from the longitudinal observational investigation of patients with unipolar MDEs showed that those with current overt irritability/anger were significantly more likely to have increased depressive severity, longer duration of the index MDE, poorer impulse control, and a more chronic and severe long-term course of illness.
Overt irritability and anger were also associated with higher rates of lifetime comorbid substance abuse and anxiety disorder, more antisocial and personality disorders, greater psychosocial impairment, reduced life satisfaction, and a higher rate of bipolar II disorder in relatives.
The study findings strongly suggest that "concurrent anger/irritability symptoms are important indicators of increased severity, chronicity, and complexity of unipolar major depression," the authors, led by Lewis L. Judd, MD, University of California, San Diego, write.
The study was published online September 11 in JAMA Psychiatry.
Prevalent and Telling
Symptoms of irritability or anger are not central to the diagnosis of unipolar MDEs. Yet, "as a clinician with considerable experience in treating major depressive disorder, I became very impressed with the amount of irritability and anger comorbid with MDEs," Dr. Judd told Medscape Medical News. "We set about to find out what was the impact of this comorbidity on the depressive disorder itself."
Dr. Lewis Judd
The investigators examined the prevalence of overtly expressed irritability/anger in MDE and its association with illness presentation and long-term course in 536 patients followed for up to 31 years.
The researchers found that more than half (292 of 536, or 54.5%) exhibited overt irritability/anger during the first unipolar MDE evaluated at entry into the study.
"Although the irritable group did not have more MDEs prior to study intake or during follow-up, their study intake MDEs lasted longer, and their prospectively observed course of affective illness was significantly more chronic (more time symptomatic) and severe (more of follow-up in a major affective episode)," the authors write.
"In addition to a greater symptomatic burden of illness and psychosocial dysfunction, they also had significantly more comorbidities with anxiety and substance use disorders," they add.
The findings were not explained by comorbidity or other manic spectrum symptoms. There was no association between irritability/anger and increased suicidal ideation or behavior.
These patients need "closer clinical monitoring," the study team notes.
They add that the treatment plan for this population "should include specific strategies to address anger management issues, as well as the frequently associated problems of comorbid anxiety disorder, substance abuse disorder, poor impulse control, and psychosocial impairment when these are present."
Distinct MDD Subtype?
"The most important finding in this paper is that it confirms...that the majority of people with irritability and depression do not have bipolar disorder," Roy H. Perlis, MD, director of the Bipolar Clinical Program at Massachusetts General Hospital and associate professor of psychiatry at Harvard Medical School in Boston, who was not involved in the study, told Medscape Medical News.
The finding that irritability is primarily a marker of greater depression severity is "quite consistent with what multiple previous studies have reported," he added.
Dr. Judd and colleagues believe their findings "support the possibility" that unipolar depression with overt irritability/anger may be a marker for a distinct subtype of unipolar MDD. "Correlates such as poor anger management, poor impulse control, increased substance abuse, and greater long-term psychosocial dysfunction raise the question of whether MDEs with irritability/anger arise from a distinct biological substrate," they write.They call for further research is to explore how combinations of biological mechanisms, personality vulnerabilities, poor social circumstances, or prior trauma may be involved in the pathogenesis of MDE with overt irritability/anger.
"Findings from such research could lead to the identification of a distinct subtype of unipolar MDD, along with specific diagnostic tools and more effective treatments," they conclude.
The initial funding source for the database used in this study was the National Institute of Mental Health. The authors' disclosures are listed in the original article. Dr. Perlis reports no relevant financial relationships.
JAMA Psychiatry. Published online September 11, 2013
Posted by Zyprexa on September 13, 2013, at 22:35:09
In reply to Irritability Anger Indication Of Complex Severe De, posted by Phillipa on September 13, 2013, at 20:55:52
And I have plenty to be angry about!
Maybe this disorder comes from past abuses infliced on these people. Builds and builds and builds. Till you can't take it anymore. The only things that work are meds and drugs. Why talk to people who are inflicting this on you, won't help.
Zyprexa!
Posted by Christ_empowered on September 14, 2013, at 7:50:30
In reply to Irritability Anger Indication Of Complex Severe De, posted by Phillipa on September 13, 2013, at 20:55:52
This is what bothers me about psychiatry, especially as it deals with poor(er) people. They push and push and push, refuse to put people into bio-psycho-social context, then diagnose and prescribe.
For instance, before my upper-middle class parents were solidly behind me, I was in a mental hospital. I had a head injury (concussion) from a botched mugging. The EMT had administered a sedative before admitting me. The staff pushed and pushed me, yelling at me, etc., and I became violent. Their diagnosis? Violent schizophrenia. The solution? Involuntary ECT.
Now, my upper-middle class parents *are* behind me. Shrinks are a lot nicer than before. I get that magical thing that proves so elusive for most mental patients..."compassion." The big "C" factor. That and I have a shrink committed to treating people with severe mental problems (now the diagnosis is Bipolar I of some sort) with compassion.
I dunno...psychiatry is dominated by the upper classes, mostly white men. Women, the poor, and minorities suffer. In the US, even the middle and lower-middle classes get poor treatment. Only when you are upper middle class or, in my case, have upper middle (or wealthy) people behind you do you seem to get empathy and compassion.
Posted by Sheilac on September 14, 2013, at 13:44:20
In reply to Re: Irritability Anger Indication Of Complex Severe De, posted by Christ_empowered on September 14, 2013, at 7:50:30
This sounds a lot like me. But now, what meds to treat?
Posted by Phillipa on September 14, 2013, at 21:03:50
In reply to What meds?, posted by Sheilac on September 14, 2013, at 13:44:20
Didn't the article mention something about now being able to develop meds to treat this? Phillipa
Posted by sigismund on September 14, 2013, at 23:46:52
In reply to Re: Irritability Anger Indication Of Complex Severe De, posted by Christ_empowered on September 14, 2013, at 7:50:30
> Their diagnosis? Violent schizophrenia. The solution? Involuntary ECT.
I thought I was unshockable.
Yeah, it is hard to imagine someone having rages on pot.
Posted by sigismund on September 14, 2013, at 23:49:53
In reply to Irritability Anger Indication Of Complex Severe De, posted by Phillipa on September 13, 2013, at 20:55:52
>These patients need "closer clinical monitoring," the study team notes.
I'm not convinced. But it is so hard to read. I get irritable and angry.
Posted by Sheilac on September 15, 2013, at 6:02:08
In reply to Irritability Anger Indication Of Complex Severe De, posted by Phillipa on September 13, 2013, at 20:55:52
Yea, they need to hurry up with newer better meds with less sideceffectsvto treat these conditions. I think pdocs are wrongly labeling and handing out wrong meds.
Posted by SLS on September 15, 2013, at 6:38:41
In reply to Re: Irritability Anger Indication Of Complex Severe De, posted by Sheilac on September 15, 2013, at 6:02:08
> Yea, they need to hurry up with newer better meds with less sideceffectsvto treat these conditions. I think pdocs are wrongly labeling and handing out wrong meds.
I agree with you. I don't know about psychiatrists being wrongly labelled, but they often hand out the "wrong" meds for a general lack of data and understanding. Ketamine itself may not be an ideal treatment, but it has opened a door into new investigations and theories regarding depression and bipolar disorder. There is at least one NMDA glutamate drug currently being investigated that can be taken orally. It works on the same receptor as does ketamine, but via a very different mechanism. These new drugs being developed by Naurex are partial agonists at the glycine site rather than being complete channel blockers like ketamine. Unfortunately, these drugs are several years away from being marketed. GLYX-13 is an i.v. drug that is worth following. If it works, then the oral agents like NRX-1074 might be equally effective.
- Scott
Posted by bleauberry on September 16, 2013, at 17:00:05
In reply to Irritability Anger Indication Of Complex Severe De, posted by Phillipa on September 13, 2013, at 20:55:52
Well if you were to ask me, I would say the irritability anger thing is more likely Bartonella. Just the results of my observations of folks with those symptoms treated with antibiotics. All the meds and herbs in the world were not needed after all. It's amazing, if we deal directly with the actual problem, all the symptoms seem to magically just go away all by themselves. Anyway, Bart is common in Lyme, 9 people out of 10 that have lyme don't know they have lyme so that's a whole lot of sick people with a wrong label, and it comes from cats and other bugs too.
These scientists sometimes make things more complicated than it is. I think maybe what they meant was that the clinical presentation was more complex. The causes really aren't that hard, except they never look at that.
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