Am J Psychiatry 1993; 150:1158-1163
Copyright © 1993 by American Psychiatric Association
Anger attacks in unipolar depression, Part 1: Clinical correlates and response to fluoxetine treatment
M Fava, JF Rosenbaum, JA Pava, MK McCarthy, RJ Steingard and E Bouffides
Clinical Psychopharmacology Unit, Massachusetts General Hospital, Boston 02114.
OBJECTIVE: Anger attacks are sudden, intense spells of anger associated
with a surge of autonomic arousal including such symptoms as tachycardia,
sweating, flushing, and a feeling of being out of control. The purpose of
this study was to determine whether depressed patients with and without
anger attacks exhibit distinct psychological characteristics and whether
these attacks respond to treatment with fluoxetine. METHOD: The Anger
Attacks Questionnaire, the Hamilton Rating Scale for Depression, the
Symptom Questionnaire, and the Cook- Medley Hostility Scale were among the
scales administered at the Depression Research Program of the Clinical
Psychopharmacology Unit at the Massachusetts General Hospital to 127
medication-free outpatients with major depression and to 85 of these
patients after 8 weeks of open treatment with a fixed dose (20 mg/day) of
fluoxetine. RESULTS: At baseline, 44% of the depressed outpatients reported
having anger attacks; these patients had significantly higher scores on
measures of anxiety, somatization, and state and trait hostility than did
the subjects who did not exhibit such attacks. After treatment, there were
significant reductions in these measures, and the anger attacks disappeared
in the majority (71%) of the patients who had previously reported them.
There was a trend toward greater overall clinical improvement for patients
with anger attacks than for patients without them. CONCLUSIONS: This study
identified a subgroup of highly irritable and hostile depressed patients
who report the presence of anger attacks and have a psychological profile
distinct from that of depressed patients without anger attacks.
Furthermore, fluoxetine treatment appears to be beneficial in reducing
anger and hostility in these patients.
