Prevalence and Clinical Correlates of Irritability in Major Depressive Disorder: A Preliminary Report From the Sequenced Treatment Alternatives to Relieve Depression Study
J Clin Psychiatry 2005;66(2):159-166
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Irritability is a common feature of
major depressive disorder (MDD), though it is not included in the
DSM-IV diagnostic criteria for adult MDD and is not assessed in
most standard depression rating scales. Irritability with or
without depression has been associated with risk for suicide,
violence, and cardiovascular disease.
Method: The prevalence of significant levels of
irritability was examined among the first 1456 outpatients with
nonpsychotic MDD entering the Sequenced Treatment Alternatives to
Relieve Depression (STAR*D) study. Sociodemographic and clinical
features were compared for participants who did and did not
report irritability at least 50% of the time during the week
preceding study entry.
Results: Of 1456 evaluable subjects, 582 (40%)
reported irritability more than half the time. These individuals
were more likely than nonirritable subjects to be female, to be
younger, to be unemployed, and to report a history of at least 1
suicide attempt. Functional status and quality of life were also
poorer in this group. Irritability was correlated with overall
depressive severity, which accounted for nearly all of the
clinical differences noted, with the exception of vascular
disease, for which the association persisted after controlling
for age, sex, and depressive severity.
Conclusion: Irritability is prevalent among
depressed outpatients and associated with a greater likelihood of
suicide attempts, poorer functional status, and greater
prevalence of vascular disease. It is correlated with overall
depression severity and thus may not represent a distinct
depressive subtype per se. The impact of irritability on course
and treatment outcome merits further study.