Depression is a serious and potentially life-threatening mental illness, which does not only lead to personal suffering but also impairs social functioning and has a significant socioeconomic effect. Epidemiological studies have found a life-time prevalence of up to 17% in the general population and death due to suicides of up to 15%. As women have a two-fold higher prevalence for depressive disorder, it is noteworthy that suicide rates are consistently higher for men. Previous studies have suggested that mainly men suffer from a specific irritable depressive syndrome, which is characterized by lowered impulse control, symptomatic substance abuse, an increased readiness to take risks, and anger attacks, which present as sudden spells of inappropriate anger with vegetative hyperarousal. This article reviews gender-specific aspects of depressive disorder focussing on anger attacks and their clinical management.
Get full access to this article
View all access options for this article.
References
1.
MurrayC.J.L., LopezA.D.Global mortality, disability, and the contribution of risk factors: Global burden of disease study. The Lancet, 1997; 349:1436–1442.
2.
MurrayC.J.L., LopezA.D.Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study. The Lancet, 1997; 349:1498–1504.
3.
BlazerD.G., KesslerR.C., McGonagleK.A., SwartzM.S.The prevalence and distribution of major depression in a national community sample: the National Comorbidity Survey. Am J Psychiatry, 1994; 151:979–986.
4.
KesslerR.C., McGonagleK.A., NelsonC.B., HughesM., SwartzM., BlazerD.G.Sex and depression in the National Comorbidity Survey. II: Cohort effects. J Affect Disord, 1994; 30:15–26.
5.
World Health Organization. World Health Statistics Annual 1995. Geneva, WHO, 1996.
6.
Arsenault-LapierreG., KimC., TureckiG.Psychiatric diagnoses in 3275 suicides: a meta-analysis. BMC Psychiatry, 2004; 4:37.
7.
DenningD.G., ConwellY., KingD., CoxC.Method choice, intent, and gender in completed suicide. Suicide and Life-Threatening Behavior, 2000; 30:282–288.
8.
Möller-LeimkühlerA.M.The gender gap in suicide and premature death or: why are men so vulnerable?. Eur Arch Psychiatry and Clin Neurosci, 2003; 253:1–8.
9.
Möller-LeimkühlerA.M.Barriers to help-seeking by men: a review of sociocultural and clinical literature with particular reference to depression. J Affect Disord, 2002; 71:1–9.
10.
ThomB.Risk-taking behaviour in men - Substance use and gender. London, ISBN 1-84279-148-6, http://www.hda.nhs.ukHealth Development Agency, 2003.
11.
RutzW., von KnorringL., PihlgrenH., RihmerZ., WalinderJ.Prevention of male suicides: lessons from Gotland study. The Lancet, 1995; 345:524.
12.
HammenC.L., PadeskyC.A.Sex differences in the expression of depressive responses on the Beck Depression Inventory. J Abnorm Psychol, 1977; 86:609–614.
13.
SteerR.A., BeckA.T., BrownG.Sex differences on the revised Beck Depression Inventory for outpatients with affective disorders. J Pers Assess, 1989; 53:693–702.
14.
KornsteinS.G., SchatzbergA.F., YonkersK.A., ThaseM.E., KeitnerG.I., RyanC.E., et al.Gender differences in presentation of chronic major depression. Psychopharmacol Bull, 1995; 31:711–718.
15.
WinklerD., PjrekE., HeidenA., WieseggerG., KleinN., KonstantinidisA., et al.Gender differences in the psychopathology of depressed inpatients. Eur Arch Psychiatry Clin Neurosci, 2004; 254:209–214.
16.
Moller-LeimkuhlerA.M., BottlenderR., StraussA., RutzW.Is there evidence for a male depressive syndrome in inpatients with major depression?. J Affect Disord, 2004; 80:87–93.
17.
SutterJ.M., HuberJ.P., LuccioniH., DufourH.AMDP system and psychopathology. Acta Psychiatrica Belgica, 1978; 78:573–582.
18.
WinklerD., PjrekE., KasperS.Anger attacks in depression - evidence for a male depressive syndrome. Psychother Psychosom, 2005; 74:303–307.
19.
FavaM., RosenbaumJ.F., McCarthyM., PavaJ., SteingardR., BlessE.Anger attacks in depressed outpatients and their response to fluoxetine. Psychopharmacol Bull, 1991; 27:275–279.
20.
ZierauF., BilleA., RutzW., BechP.The Gotland Male Depression Scale: A validity study in patients with alcohol use disorders. Nordic Journal of Psychiatry, 2002; 56:265–271.
21.
StewartJW, McGrathPJ, RabkinJG, MQF. Atypical depression. A valid clinical entity?. The Psychiatric clinics of North America, 1993; 16:479–95.
DawsonD.Gender differences in the risk of alcohol dependence: United States, 1992. Addiction, 1996; 91:1831–1842.
24.
KrausL., BloomfieldK., AugustinR., ReeseA.Prevalence of alcohol use and the association between onset of use and alcohol-related problems in a general population sample in Germany. Addiction, 2000; 95:1389–1401.
25.
AngstJ., GammaA., GastparM., LepineJ.P., MendlewiczJ., TyleeA.Depression Research in European Society Study. Gender differences in depression. Epidemiological findings from the European DEPRES I and II studies. Eur Arch Psychiatry Clin Neurosci, 2002; 252:201–209.
26.
FavaM., VuoloR.D., WrightE.C., NierenbergA.A., AlpertJ.E., RosenbaumJ.F.Fenfluramine challenge in unipolar depression with and without anger attacks. Psychiatry Res, 2000; 94:9–18.
27.
SwannA.C.Neuroreceptor mechanisms of aggression and its treatment. J Clin Psychiatry, 2003; 64(Suppl. 4):426–435.
28.
Magistrat der Stadt Wien. Gesundheitsbericht Wien 2002 - Vienna Health Report 2002.
29.
BriscoeM.E.Why do people go to the doctor? Sex differences in the correlates of GP consultation. Social science & medicine, 1987; 25:507–513.
30.
TabenkinH., GoodwinM.A., ZyzanskiS.J., StangeK.C., MedalieJ.H.Gender differences in time spent during direct observation of doctor-patient encounters. Journal of Womens Health, 2004; 13:341–349.
31.
Möller-LeimkühlerA.M.Men and depression: gender-related help-seeking behavior. Fortschritte der Neurologie - Psychiatrie, 2000; 68:489–495.
32.
CorneyR.H.Sex differences in general practice attendance and help seeking for minor illness. J Psychosom Res, 1990; 34:525–534.
33.
MammenO.K., ShearM.K., PilkonisP.A., KolkoD.J., ThaseM.E., GreenoC.G.Anger attacks: correlates and significance of an underrecognized symptom. J Clin Psychiatry, 1999; 60:633–642.
34.
AlpertJ.E., PetersenT., RoffiP.A., PapakostasG.I., FreedR., SmithM.M., et al.Behavioral and emotional disturbances in the offspring of depressed parents with anger attacks. Psychother Psychosom, 2003; 72:102–106.
35.
WinklerD, PjrekE, KindlerJ, HeidenA, KasperS. Validation of a simplified definition of anger attacks. Psychother Psychosom, 2005; in press.
36.
World Health Organization. The ICD-10 Classification of mental and behavioral disorders: Clinical descriptions and diagnostic guidelines. Geneva, World Health Organization (WHO), 1991.
37.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorder, 4th edition, text revision (DSM-IV-TR). Washington, DC, American Psychiatric Press, 2000.
38.
KasperS, LehoferM. (Eds.), Depression – Medikamentöse Therapie. State of the Art 2001: CliniCum Sonderausgabe, 2001.
39.
FavaM., RosenbaumJ.F., PavaJ.A., McCarthyM.K., SteingardR.J., BouffidesE.Anger attacks in unipolar depression, Part 1: Clinical correlates and response to fluoxetine treatment. Am J Psychiatry, 1993; 150:1158–1163.
40.
FavaM., AlpertJ., NierenbergA.A., GhaemiN., O'SullivanR., TedlowJ., et al.Fluoxetine treatment of anger attacks: a replication study. Annals of Clinical Psychiatry, 1996; 8:7–10.
41.
FavaM., NierenbergA.A., QuitkinF.M., ZisookS., PearlsteinT., StoneA., et al.A preliminary study on the efficacy of sertraline and imipramine on anger attacks in atypical depression and dysthymia. Psychopharmacol Bull, 1997; 33:101–103.
42.
BagbyR.M., KennedyS.H., SchullerD.R., DickensS.E., MinifieC.E., LevittA., et al.Differential pharmacological treatment response in high angry hostile and low angry hostile depressed patients: a retrospective analysis. J Affect Disord, 1997; 45:161–166.
HemelsM.E.H., KasperS., WalterE., EinarsonT.R.Cost-effectiveness analysis of escitalopram: A new SSRI in the first-line treatment of major depressive disorder in Austria. Curr Med Res Opin, 2004; 20:869–878.
45.
SchatzbergA.F.Course of depression in adults: Treatment options. Psychiatric Annals, 1996; 26:336–341.
46.
WinklerD., TauscherJ., KasperS.Maintenance treatment in depression: the role of pharmacological and psychological treatment. Current Opinions in Psychiatry, 2002; 15:63–68.
47.
DemyttenaereK.Risk factors and predictors of compliance in depression. Eur Neuropsychopharmacol, 2003; 13(Suppl. 3):69–75.
48.
DemyttenaereK., EnzlinP., DeweW., BoulangerB., De BieJ., De TroyerW., et al.Compliance with antidepressants in a primary care setting, 2: the influence of gender and type of impairment. J Clin Psychiatry, 2001; 62(Suppl. 22):34–37.
49.
BaldwinD.S.Sexual dysfunction associated with antidepressant drugs. Expert Opinion on Drug Safety, 2004; 3:457–470.
50.
BauerM., WhybrowP.C., AngstJ., VersianiM., MollerH.J.WFSBP Task Force on Treatment Guidelines for Unipolar Depressive Disorders. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Unipolar Depressive Disorders, Part 1: Acute and continuation treatment of major depressive disorder. World Journal of Biological Psychiatry, 2002; 3:5–43.
51.
LeichsenringF.Comparative effects of short-term psychodynamic psychotherapy and cognitive-behavioral therapy in depression: a meta-analytic approach. Clinical Psychology Review, 2001; 21:401–419.
52.
WeissmanM.M., KlermanG.L., PrusoffB.A., SholomskasD., PadianN.Depressed outpatients. Results one year after treatment with drugs and/or interpersonal psychotherapy. Arch Gen Psychiatry, 1981; 38:51–55.
53.
de JongheF., HendricksenM., van AalstG., KoolS., PeenV., VanR., et al.Psychotherapy alone and combined with pharmacotherapy in the treatment of depression. Br J Psychiatry, 2004; 185:37–45.
54.
LinehanM.M., HeardH.L., ArmstrongH.E.Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline patients. Arch Gen Psychiatry, 1993; 50:971–974.
55.
EllisA.Group rational-emotive and cognitive-behavioral therapy. Int J Group Psychother, 1992; 42:63–80.
56.
ZieglerD.J., SmithP.N.Anger and the ABC model underlying Rational-Emotive Behavior Therapy. Psychol Rep, 2004; 94:1009–1014.
57.
KasperS. (Ed), Depression beim Mann: CliniCum Sonderdruck. 2000.
58.
RainerM., Kruger-RainerC.The geriatric psychiatry patient - a new indications field for psychotherapy?. Wiener Medizinische Wochenschrift, 2003; 153:506–511.
59.
RutzW., WalinderJ., von KnorringL., RihmerZ., PihlgrenH.Prevention of depression and suicide by education and medication: impact on male suicidality. An update from the Gotland study. International Journal of Psychiatry in Clinical Practice, 1997; 1:39–46.
