ANGER ATTACKS IN UNIPOLAR DEPRESSION .1. CLINICAL CORRELATES AND RESPONSE TO FLUOXETINE TREATMENT

Objective: Anger attacks are sudden, intense spells of anger associate d with a surge of autonomic arousal including such symptoms as tachyca rdia, sweating, flushing, and a feeling of being out of control. The p urpose of this study was to determine whether depressed patients with and without anger attacks exhibit distinct psychological characteristi cs and whether these attacks respond to treatment with fluoxetine. Met hod: The Anger Attacks Questionnaire, the Hamilton Rating Scale for De pression, the Symptom Questionnaire, and the Cook-Medley Hostility, Sc ale were among the scales administered at the Depression Research Prog ram of the Clinical Psychopharmacology Unit at the Massachusetts Gener al Hospital to 127 medication-free outpatients with major depression a nd to 85 of these patients after 8 weeks of open treatment with a fixe d dose (20 mg/day) of fluoxetine. Results: At baseline, 44% of the dep ressed outpatients reported having anger attacks; these patients had s ignificantly higher scores on measures of anxiety, somatization, and s tate and trait hostility than did the subjects who did not exhibit suc h attacks. After treatment, there were significant reductions in these measures, and the anger attacks disappeared in the majority (71%) of the patients who bad previously reported them. There was a trend towar d 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 distin ct from that of depressed patients without anger attacks. Furthermore, fluoxetine treatment appears to be beneficial in reducing anger and h ostility in these patients.