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Review
. 2021 Apr;30(2):401-414.
doi: 10.1016/j.chc.2020.10.009.

How and Why Are Irritability and Depression Linked?

Pablo Vidal-Ribas  1 , Argyris Stringaris  2
Affiliations
Review

How and Why Are Irritability and Depression Linked?

Pablo Vidal-Ribas et al. Child Adolesc Psychiatr Clin N Am. 2021 Apr.

Abstract

Based on its course over time, irritability is linked to depression cross-sectionally and longitudinally. Cross-sectionally, irritability takes an episodic form as a symptom in pediatric depression; yet, irritability in the absence of depressed mood or anhedonia is rare. Longitudinally, chronic irritability has been shown to predict depression rather than bipolar disorder or externalizing disorders. Evidence suggests that the link between irritability and depression is explained mostly by shared genetic risk. Both conditions are also associated with higher rates of family history of depression, childhood temperaments and personality styles, and negative parenting styles. The treatment implications are discussed.

Keywords: Depression; Genetics; Irritability; Prospective; Risk.

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Conflict of interest statement

Disclosure Dr. Stringaris receives grant from National Institute of Mental Health Intramural Research Program Project ZIA-MH002957

Figures

Figure 1.
Figure 1.
Simplified depiction of types of irritability based on its course over time. Episodic irritability (solid line) constitutes a change from a child’s baseline mood and is present in depression and BD. Chronic irritability (dotted line) is persistent over time and is the hallmark of DMDD and ODD. Although phasic irritability (i.e., temper outbursts) and tonic irritability (i.e., irritable or angry mood between outbursts) have been usually studied in the context of chronic irritability, these also take place in the context of episodic irritability as long as the mood episode lasts.
Figure 2.
Figure 2.
Forest plot of irritability as a predictor of future psychiatric disorders. Points represent the estimated odds ratio of each study; the lines bisecting the point correspond to the 95% confidence intervals (CI). Pooled effect sizes are represented by diamonds. Weights for each study are given in the right column. ADHD: Attention deficit hyperactivity disorder. ODD: Oppositional defiant disorder. Adapted from Vidal-Ribas P, Brotman MA, Valdivieso I, et al. The Status of Irritability in Psychiatry: A Conceptual and Quantitative Review. J Am Acad Child Adolesc Psychiatry 2016;55(7):561; with permission.
Figure 3.
Figure 3.
Potential models to explain the association between irritability and depression. A. Model of shared factors between irritability and depression. B. Model of irritability as a cause of depression. C. Model of irritability as an early manifestation of depression
See this image and copyright information in PMC

References

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