Possible Bipolar Nature of Irritability in Major Depressive Disorder

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Sir: Perlis et al.1 found that irritability was present in 40% of outpatients with major depressive disorder (MDD). The finding mirrors DSM-IV-TR,2 which lists irritability not only as a core symptom of mania and hypomania, but also as a common symptom of MDD. Kraepelin3 classified irritability as a manic (excitement) symptom. The bipolar nature of irritability in MDD can have an important impact on treatment of MDD. Although a study4 on MDD with irritability showed that fluoxetine was effective in reducing irritability, clinical observations suggest adding mood-stabilizing agents to antidepressants in MDD with irritability because antidepressants alone may worsen irritability.5–9

J Clin Psychiatry 2005;66(8):1072-1072