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It’s National Mental Health Month

By Dr. James Horst, DO, FACN, National Medical Director of Behavioral Health and Post-Acute Care, TeamHealth

Are you hotheaded, irritated and generally affected by the myriad of annoyances that pop up on a daily basis? Has it been this way for a while? Are your relationships starting to falter? Is your work life starting to decline? Being angry all the time is not a healthy way of life. In fact, it is often a sign of depression. Studies show that one in four healthcare workers are clinically depressed. Depression and substance abuse are the most common psychiatric disorders. Anger and depression often go hand in hand; especially for men who are often raised to put sadness aside for the tougher, less vulnerable emotion, anger. As it happens, the persistent sadness or sorrow that typically identifies depression for most people may get buried under a mix of frustrated, anxious, stressed out crankiness for others. In those cases, anger seems to surface first as they feel unable to control or deal with their innermost hurts and insecurities. Furthermore, this type of anger may happen so often for some sufferers that depression and crucial opportunities for early depression counseling are missed altogether. Thus, suffering goes on too long, fueling pain and isolation, even draining some of the will to live. Over time, anger can also drive a wedge between depressed people and those closest to them. Co-workers and colleagues begin to treat you differently, only fueling the anger. It can push people deeper into unaddressed emotional pain, as they keep everyone at arm’s length with unpredictable rage or a constantly foul temper. Research in recent years reveals a clear link between feelings of anger and depression again and again. For example, the September 2013 edition of The Journal of the American Medical Association of Psychiatry cited a depression study that spanned three decades. Through observations of 500 people suffering from depression, it recorded a high degree of overt irritability, sudden episodes of anger and a low tolerance for discomfort in more than half the participants. These angry responses appeared to increase the severity of depression significantly and accompanied other mental health disorders during the 30 years subjects participated in the research.

While anger may be noted as a symptom of depression, it is often missed as a replacement response for sadness. Most people, including many doctors tend to think of depression only as sadness and silent withdrawal. Conversely, anger and aggression may be viewed as simply being a part of who a depressed person is. Or it may be attributed to some overall behavioral problem, instead of recognized as the most persistent clue that depression is at play. Thus, the link between anger and depression and subsequent treatment can be missed repeatedly. A person may endure additional pain due to misunderstanding and misdiagnosis. Fortunately, as more focus is directed toward depression research regarding anger management treatment and healthy expression of anger are uncovering more about the link between anger and depression. Hopefully, reading anger accurately will reduce violence and/or suicide.

Anger masking as depression?
Perhaps you know you should not be so offended all the time, so bothered by the kindness your partner tries to extend or irritated by the energy and conversation at work.
Can you think through and identify the emotions that precede your anger? Are your angry outbursts followed by hopelessness or a sense of powerlessness?
Have you been trying to rein in persistent anger for more than two weeks, months? Longer?
How would you describe what you feel when you deal with other people? Would others describe you as generally prickly or constantly pushing them away with a harsh attitude or over-the-line reactions?
Sometimes there are somatic, or bodily symptoms accompanying an anger experience. Do the following seem familiar?

  • Accelerated heartbeat?
  •  Elevated blood pressure?
  •  Rage?
  •  Aggression?

If so, are these symptoms of depression routinely familiar as well?

  • Confusion, sadness, or hopelessness following outbursts
  • Major shifts in your weight
  • Loss of interest in things you once enjoyed
  •  Energy loss, fatigue, disturbed sleep patterns
  • Unexplained aches and pains
  • Thoughts of self-harm, harming others or suicide

People who experience anger and depression combination alternately explode and suppress symptoms so you may need help determining what’s going on inside. In the meantime, there are things you can do to help yourself along the way. What can you do?

  • Acknowledge your anger. Tell yourself the truth. Anger is messing with your life.
  • Identify what’s going on internally. Name your feelings as you experience them. Increase your emotional awareness and understanding.
  • Read your anger as a signal to pay attention. Observe it and accept it rather than escape it or suppress it. Ask yourself, “Is something deeper going on?”
  • Embrace introspection. Tune into your self-talk. What do you say and how do you say it? Are you hard on yourself? Why? Take steps toward self-compassion.
  • Challenge anger-feeding beliefs that place unreasonable demands on people or situations.
  • Notice constant complaining.
  • Stop harassing others. Stop hassling yourself. It keeps you passive and unproductive, fueling more depression and frustrated anger.
  • Accept that much of life may be unfair, unpredictable or indifferent to you. This helps dispel the sense of powerlessness that comes from constantly seeking a fair, tightly controlled life.
  • Should there be an additional bullet here to advise readers who identify to seek professional help of a counselor or therapist?

The idea is to stop your depressed suffering and douse unhelpful anger as soon as possible; particularly if either experience is getting in the way of enjoying your life. You, your loved ones, co-workers and colleagues deserve the opportunity to live well, safe and emotionally intact.

As a part of TeamHealth’s commitment to physical and mental well-being, we have invested in programs to help our clinicians and non-clinical associates in need. In 2016, we began working to enhance available resources through LiveWell WorkLife services. The counseling services offer three free in-person visits per topic relative to area and include:

  • Legal support
  • Mediation
  • Financial support
  • Adult/Elder Services
  • Child/Parenting Services
  • Convenience Services
  •  Life Learning
  • Chronic Condition Support Services
  • Critical Response Support
  • 24/7/365 phone number to call
  • Counseling services – three free in-person visits per topic relative to area.

These health resources and personalized support services help our clinical and non-clinical associates find the balance, support and care needed to live the healthiest lives possible.

For more information on this program and to sign up for services, contact