From the Guidelines
I strongly recommend consulting with a healthcare provider to evaluate potential causes of chronic anger and irritability, which could include underlying medical conditions, mental health issues, or lifestyle factors. Start by seeing your primary care physician for a comprehensive physical exam, including blood tests to check thyroid function, hormone levels (particularly testosterone and estrogen), vitamin deficiencies (especially B vitamins, vitamin D, and magnesium), and blood sugar regulation, as these physiological factors can significantly impact mood regulation 1. Additionally, seek evaluation for possible mental health conditions like depression, anxiety disorders, bipolar disorder, or ADHD, which often manifest as irritability, and consider how sleep quality, stress levels, substance use (including alcohol, caffeine, and recreational drugs), and diet might be contributing factors. Some key points to consider in the evaluation process include:
- Manic-like symptoms of irritability and emotional reactivity may be found in a number of conditions, including disruptive behavior disorders, posttraumatic stress disorder, and pervasive developmental disorders 1
- The pattern of illness, duration of symptoms, and association with psychomotor, sleep, and cognitive changes are important diagnostic clues 1
- A thorough workup can rule out other confounding illnesses and identify comorbid disorders that need to be addressed as part of a comprehensive treatment plan 1
- Treatment approaches will depend on the underlying cause but might include medication (such as antidepressants, mood stabilizers, or hormone therapy), therapy (particularly cognitive-behavioral therapy), stress management techniques, lifestyle modifications, or a combination of these interventions. Keeping a mood journal for 2-3 weeks before your appointment can help identify patterns and triggers. It's also important to note that some medications, such as risperidone, have been shown to improve symptoms of irritability and aggression in youth with intellectual disability (intellectual developmental disorder) 1, but should be considered after assessments of whether potential contributors to irritability and aggression could be addressed by nonpharmacological means.
From the FDA Drug Label
Symptoms that occur as a result of exposure to the traumatic event include ... irritability or outbursts of anger The essential features of PMDD include ... persistent anger or irritability.
The cause of your persistent irritability and anger may be related to an underlying condition such as Posttraumatic Stress Disorder (PTSD) or Premenstrual Dysphoric Disorder (PMDD), as these conditions are characterized by symptoms of irritability and anger 2. However, the FDA drug label does not provide a direct answer to the question of what is causing your specific symptoms.
From the Research
Possible Causes of Persistent Irritability and Anger
- Intense anger, easy irritability, and low frustration tolerance can occur as part of various Axis I and Axis II diagnoses 3
- Irritability can be a distinct dimension with substantial stability across time and is specifically associated with depression and anxiety in longitudinal studies 4
- Anger, hostility, and irritability are frequently observed among patients with unipolar depressive disorders, with approximately one-third of depressed outpatients presenting with "anger attacks" 5
Relationship with Other Conditions
- Irritability is moderately heritable, and its overlap with depression is explained mainly by genetic factors 4
- Behavioral and neuroimaging studies show that individuals with persistent irritability exhibit altered activations in the amygdala, striatum, and frontal regions compared to healthy volunteers 4
- Depressed patients with anger attacks are significantly more anxious and hostile and are more likely to meet criteria for certain personality disorders than depressed patients without anger attacks 5
Treatment Options
- Fluoxetine has been suggested as a potential treatment for anger and irritability, with studies showing clinical improvement in patients with intense anger 3 and depressed patients with anger attacks 5
- Behavioral interventions, such as parent management training and cognitive-behavioral therapy, have received extensive support in randomized controlled trials for treating anger, irritability, and aggression in children and adolescents 6
- A novel psychoeducational treatment program, Anger Self-Management Training, has been developed for individuals with chronic traumatic brain injury and significant cognitive impairment, with a focus on anger self-management 7