Depression and Anger

We usually think of depression as a form of prolonged sadness, being “down” for a disturbingly long time. But depression can also take the form of irritability in children and teenagers. And irritability — a tendency to react angrily to slight annoyances or provocations — can result in everything from angry outbursts in younger children to cutting or snide remarks in teenagers.

“What we see with younger kids and teenagers is they’re always feeling annoyed or feeling on edge,” explains Lauren Allerhand, PsyD, a clinical psychologist at the Child Mind Institute. “They always appear to be a little bit frustrated, like they’re simmering under the surface.”

In some kids, irritability replaces the depressed mood that we think of as the defining symptom of depression. In others it appears along with feeling down. “What I see most often is kids who experience both,” adds Dr. Allerhand. “It’s like an inability to experience positive emotions. They’re waffling between this irritability and low mood.”

Dr. Allerhand notes that it can be helpful for parents to know that anger can be what is called a “secondary emotion.” That means that for some people – kids or adults — it’s easier to experience anger than sadness or loss or grief. “The locus of anger is usually external,” she notes, so it can be easier to be angry with those around you than to acknowledge some very painful negative feelings. It makes sense, then, that kids who are feeling deep sadness might express anger instead.

There are many things that can prompt irritability and anger in young people. What are the signs that these negative moods might be associated with depression?

If the irritability is constant rather than conditional. We expect some level of irritability from teenagers in general, especially when they’re being asked to do something they don’t want to do, like put down their phones and join the family for dinner. But that typical kind of irritation or anger is intermittent, and it’s provoked by something specific.

“However, if irritation is the main way that a teenager is throughout the day,” says Dr. Allerhand, “and not only at home but also at school or in other environments, it may be related to a mood disorder rather than an environmental circumstance.”

If the irritability is accompanied by other symptoms of depression. In addition to depressed mood or irritability, to be diagnosed with depression a child would have to have at least four of these symptoms:

• Losing interest in things they once enjoyed
• Feeling worthless, saying negative things about themselves
• Lacking energy, feeling tired or seeming lazy
• Trouble concentrating or making decisions
• Gaining or losing weight, changes in appetite
• Trouble sleeping or sleeping too much
• Thinking about or attempting suicide

Irritability with high energy could be caused by anxiety. Depression generally comes with low energy levels. So when irritability appears with high energy, or it is accompanied by a lot of worried behavior, Dr. Allerhand says it’s more likely to be associated with anxiety. Or, in some cases, it can be a sign of bipolar disorder. “I would look at anxiety first,” she said, “unless there was a very strong family history of bipolar or some very strong indicators, because that’s much less common.”

If the irritability is explosive, it could be DMDD. When a child regularly has explosive outbursts of anger with seemingly little provocation, they may have the relatively new disorder called disruptive mood dysregulation disorder, or DMDD. “Those are the kids who go from zero to 100, throwing stuff, hitting — those really big tantrums, big displays,” notes Dr. Allerhand. The kind of irritability associated with depression is more of a steady state of being on edge, and prone to snap at someone or lash out verbally. DMDD usually shows up before age ten, but it isn’t diagnosed in kids younger than six, since temper tantrums are common in very young children.

If you’re wondering if the irritability or anger you’re seeing from a child or teenager could be a sign of depression, Dr. Allerhand has these recommendations:

Talk to them about how they’re feeling. If your child seems unusually irritable, something may be going on that’s driving the behavior. A good place to start is having a conversation with them to see if there’s something at school or at home that’s causing them stress.

“Start with something open-ended like, ‘How have you been feeling lately? I know things have been tough,’ ” she suggests. “See what the child says. If they are open to talking about how they feel, great! Parents should listen and validate without jumping immediately to problem solving — unless the child is specifically asking for problem solving.”

If the child is unresponsive to first attempts, Dr. Allerhand encourages parents to let it go and let the child know they are always available to chat. “I’d recommend doing this often — even daily — so they will come to you when they’re ready,” she says. “This shouldn’t be a power struggle, or kids will never want to share.”

If it’s less than constant, try to ignore it. If your child’s irritability seems to be triggered by things they don’t want to do, or they’re irritable in the morning but pleasant in the afternoon, it’s less likely to be a sign of a mood disorder. “If it’s more conditional and not happening all the time, I would ignore it as much as you possibly can,” advises Dr. Allerhand. “It’s best to avoid saying things like, ‘That’s disrespectful,’ or, ‘You don’t talk to me like that.’ Any of that kind of attention is going to increase the likelihood that you see more of it.”

On the other hand, do praise behavior you do want to see: “So anytime they come down to the dinner table and sit down and grunt one word at you, you say, ‘Thank you so much. I love when you have dinner with us.’ No sarcasm either.”

If it’s only happening at home, you probably don’t need to worry. Even if a teenager is irritable most of the time at home, if they’re happy at school or in other environments, then it’s more likely to be typical edginess than a mood disorder, Dr. Allerhand advises.

Teenagers tend to direct anger and irritability towards parents, since venting is less risky where you are most secure. “Forming strong peer relationships is a high priority for teenagers. And if you’re irritable and blow up at people, they don’t generally want to be your friend. So oftentimes kids save it for the people who they have the most secure relationships with,” adds Dr. Allerhand.

And since parents have control over so much of a child’s – and even a teenager’s — life, they’re very easy targets for irritation and anger.

If your child’s irritability and anger are a pattern that’s going on every day, for more than a couple of weeks, and outside the home as well as with the family, it’s a good idea to consult a mental health professional. Especially when it’s caught early, depression is very treatable. Treatment for depression includes both medication and specialized forms of cognitive behavioral therapy that focus on helping kids learn to cope with difficult emotions.