Anger outburst depression

SAMHSA’s National Helpline | SAMHSA

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SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.
Also visit the online treatment locator.

SAMHSA’s National Helpline, 1-800-662-HELP (4357) (also known as the Treatment Referral Routing Service), or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.

Also visit the online treatment locator, or send your zip code via text message: 435748 (HELP4U) to find help near you. Read more about the HELP4U text messaging service.

The service is open 24/7, 365 days a year.

English and Spanish are available if you select the option to speak with a national representative. Currently, the 435748 (HELP4U) text messaging service is only available in English.

In 2020, the Helpline received 833,598 calls. This is a 27 percent increase from 2019, when the Helpline received a total of 656,953 calls for the year.

The referral service is free of charge. If you have no insurance or are underinsured, we will refer you to your state office, which is responsible for state-funded treatment programs. In addition, we can often refer you to facilities that charge on a sliding fee scale or accept Medicare or Medicaid. If you have health insurance, you are encouraged to contact your insurer for a list of participating health care providers and facilities.

The service is confidential. We will not ask you for any personal information. We may ask for your zip code or other pertinent geographic information in order to track calls being routed to other offices or to accurately identify the local resources appropriate to your needs.

No, we do not provide counseling. Trained information specialists answer calls, transfer callers to state services or other appropriate intake centers in their states, and connect them with local assistance and support.

Suggested Resources
What Is Substance Abuse Treatment? A Booklet for Families
Created for family members of people with alcohol abuse or drug abuse problems. Answers questions about substance abuse, its symptoms, different types of treatment, and recovery. Addresses concerns of children of parents with substance use/abuse problems.
It's Not Your Fault (NACoA) (PDF | 12 KB)
Assures teens with parents who abuse alcohol or drugs that, "It's not your fault!" and that they are not alone. Encourages teens to seek emotional support from other adults, school counselors, and youth support groups such as Alateen, and provides a resource list.

After an Attempt: A Guide for Taking Care of Your Family Member After Treatment in the Emergency Department
Aids family members in coping with the aftermath of a relative's suicide attempt. Describes the emergency department treatment process, lists questions to ask about follow-up treatment, and describes how to reduce risk and ensure safety at home.
Family Therapy Can Help: For People in Recovery From Mental Illness or Addiction
Explores the role of family therapy in recovery from mental illness or substance abuse. Explains how family therapy sessions are run and who conducts them, describes a typical session, and provides information on its effectiveness in recovery.
For additional resources, please visit the SAMHSA Store.

Last Updated: 08/30/2022

Alcohol, Tobacco, and Other Drugs

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Misusing alcohol, tobacco, and other drugs can have both immediate and long-term health effects.

The misuse and abuse of alcohol, tobacco, illicit drugs, and prescription medications affect the health and well-being of millions of Americans. NSDUH estimates allow researchers, clinicians, policymakers, and the general public to better understand and improve the nation’s behavioral health. These reports and detailed tables present estimates from the 2021 National Survey on Drug Use and Health (NSDUH).

Alcohol

Data:

Among the 133.1 million current alcohol users aged 12 or older in 2021, 60.0 million people (or 45.1%) were past month binge drinkers. The percentage of people who were past month binge drinkers was highest among young adults aged 18 to 25 (29.2% or 9.8 million people), followed by adults aged 26 or older (22.4% or 49.3 million people), then by adolescents aged 12 to 17 (3.8% or 995,000 people). (2021 NSDUH)
Among people aged 12 to 20 in 2021, 15.1% (or 5.9 million people) were past month alcohol users. Estimates of binge alcohol use and heavy alcohol use in the past month among underage people were 8.3% (or 3.2 million people) and 1.6% (or 613,000 people), respectively. (2021 NSDUH)

In 2020, 50.0% of people aged 12 or older (or 138.5 million people) used alcohol in the past month (i.e., current alcohol users) (2020 NSDUH)
Among the 138.5 million people who were current alcohol users, 61.6 million people (or 44. 4%) were classified as binge drinkers and 17.7 million people (28.8% of current binge drinkers and 12.8% of current alcohol users) were classified as heavy drinkers (2020 NSDUH)
The percentage of people who were past month binge alcohol users was highest among young adults aged 18 to 25 (31.4%) compared with 22.9% of adults aged 26 or older and 4.1% of adolescents aged 12 to 17 (2020 NSDUH)
Excessive alcohol use can increase a person’s risk of stroke, liver cirrhosis, alcoholic hepatitis, cancer, and other serious health conditions
Excessive alcohol use can also lead to risk-taking behavior, including driving while impaired. The Centers for Disease Control and Prevention reports that 29 people in the United States die in motor vehicle crashes that involve an alcohol-impaired driver daily

Programs/Initiatives:

STOP Underage Drinking interagency portal - Interagency Coordinating Committee on the Prevention of Underage Drinking
Interagency Coordinating Committee on the Prevention of Underage Drinking
Talk. They Hear You.
Underage Drinking: Myths vs. Facts
Talking with your College-Bound Young Adult About Alcohol

Relevant links:

National Association of State Alcohol and Drug Abuse Directors
Department of Transportation Office of Drug & Alcohol Policy & Compliance
Alcohol Policy Information Systems Database (APIS)
National Institute on Alcohol Abuse and Alcoholism

Tobacco

Data:

In 2020, 20.7% of people aged 12 or older (or 57.3 million people) used nicotine products (i.e., used tobacco products or vaped nicotine) in the past month (2020 NSDUH)
Among past month users of nicotine products, nearly two thirds of adolescents aged 12 to 17 (63.1%) vaped nicotine but did not use tobacco products. In contrast, 88.9% of past month nicotine product users aged 26 or older used only tobacco products (2020 NSDUH)
Tobacco use is the leading cause of preventable death, often leading to lung cancer, respiratory disorders, heart disease, stroke, and other serious illnesses. The CDC reports that cigarette smoking causes more than 480,000 deaths each year in the United States
The CDC’s Office on Smoking and Health reports that more than 16 million Americans are living with a disease caused by smoking cigarettes

Electronic cigarette (e-cigarette) use data:

In 2021, 13.2 million people aged 12 or older (or 4.7%) used an e-cigarette or other vaping device to vape nicotine in the past month. The percentage of people who vaped nicotine was highest among young adults aged 18 to 25 (14.1% or 4.7 million people), followed by adolescents aged 12 to 17 (5.2% or 1.4 million people), then by adults aged 26 or older (3.2% or 7.1 million people).
Among people aged 12 to 20 in 2021, 11.0% (or 4.3 million people) used tobacco products or used an e-cigarette or other vaping device to vape nicotine in the past month. Among people in this age group, 8.1% (or 3.1 million people) vaped nicotine, 5.4% (or 2.1 million people) used tobacco products, and 3. 4% (or 1.3 million people) smoked cigarettes in the past month. (2021 NSDUH)
Data from the Centers for Disease Control and Prevention’s 2020 National Youth Tobacco Survey. Among both middle and high school students, current use of e-cigarettes declined from 2019 to 2020, reversing previous trends and returning current e-cigarette use to levels similar to those observed in 2018
E-cigarettes are not safe for youth, young adults, or pregnant women, especially because they contain nicotine and other chemicals

Resources:

Tips for Teens: Tobacco
Tips for Teens: E-cigarettes
Implementing Tobacco Cessation Programs in Substance Use Disorder Treatment Settings
Synar Amendment Program

Links:

Truth Initiative
FDA Center for Tobacco Products
CDC Office on Smoking and Health
National Institute on Drug Abuse: Tobacco, Nicotine, and E-Cigarettes
National Institute on Drug Abuse: E-Cigarettes

Opioids

Data:

Among people aged 12 or older in 2021, 3. 3% (or 9.2 million people) misused opioids (heroin or prescription pain relievers) in the past year. Among the 9.2 million people who misused opioids in the past year, 8.7 million people misused prescription pain relievers compared with 1.1 million people who used heroin. These numbers include 574,000 people who both misused prescription pain relievers and used heroin in the past year. (2021 NSDUH)
Among people aged 12 or older in 2020, 3.4% (or 9.5 million people) misused opioids in the past year. Among the 9.5 million people who misused opioids in the past year, 9.3 million people misused prescription pain relievers and 902,000 people used heroin (2020 NSDUH)
According to the Centers for Disease Control and Prevention’s Understanding the Epidemic, an average of 128 Americans die every day from an opioid overdose

Resources:

Medications for Substance Use Disorders
Opioid Overdose Prevention Toolkit
TIP 63: Medications for Opioid Use Disorder
Use of Medication-Assisted Treatment for Opioid Use Disorder in Criminal Justice Settings
Opioid Use Disorder and Pregnancy

Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants
The Facts about Buprenorphine for Treatment of Opioid Addiction
Pregnancy Planning for Women Being Treated for Opioid Use Disorder
Tips for Teens: Opioids
Rural Opioid Technical Assistance Grants
Tribal Opioid Response Grants
Provider’s Clinical Support System - Medication Assisted Treatment Grant Program

Links:

National Institute on Drug Abuse: Opioids
National Institute on Drug Abuse: Heroin
HHS Prevent Opioid Abuse
Community Anti-Drug Coalitions of America
Addiction Technology Transfer Center (ATTC) Network
Prevention Technology Transfer Center (PTTC) Network

Marijuana

Data:

In 2021, marijuana was the most commonly used illicit drug, with 18. 7% of people aged 12 or older (or 52.5 million people) using it in the past year. The percentage was highest among young adults aged 18 to 25 (35.4% or 11.8 million people), followed by adults aged 26 or older (17.2% or 37.9 million people), then by adolescents aged 12 to 17 (10.5% or 2.7 million people).
The percentage of people who used marijuana in the past year was highest among young adults aged 18 to 25 (34.5%) compared with 16.3% of adults aged 26 or older and 10.1% of adolescents aged 12 to 17 (2020 NSDUH)
Marijuana can impair judgment and distort perception in the short term and can lead to memory impairment in the long term
Marijuana can have significant health effects on youth and pregnant women.

Resources:

Know the Risks of Marijuana
Marijuana and Pregnancy
Tips for Teens: Marijuana

Relevant links:

National Institute on Drug Abuse: Marijuana
Addiction Technology Transfer Centers on Marijuana
CDC Marijuana and Public Health

Emerging Trends in Substance Misuse:

Methamphetamine—In 2019, NSDUH data show that approximately 2 million people used methamphetamine in the past year. Approximately 1 million people had a methamphetamine use disorder, which was higher than the percentage in 2016, but similar to the percentages in 2015 and 2018. The National Institute on Drug Abuse Data shows that overdose death rates involving methamphetamine have quadrupled from 2011 to 2017. Frequent meth use is associated with mood disturbances, hallucinations, and paranoia.
Cocaine—In 2019, NSDUH data show an estimated 5.5 million people aged 12 or older were past users of cocaine, including about 778,000 users of crack. The CDC reports that overdose deaths involving have increased by one-third from 2016 to 2017. In the short term, cocaine use can result in increased blood pressure, restlessness, and irritability. In the long term, severe medical complications of cocaine use include heart attacks, seizures, and abdominal pain.
Kratom—In 2019, NSDUH data show that about 825,000 people had used Kratom in the past month. Kratom is a tropical plant that grows naturally in Southeast Asia with leaves that can have psychotropic effects by affecting opioid brain receptors. It is currently unregulated and has risk of abuse and dependence. The National Institute on Drug Abuse reports that health effects of Kratom can include nausea, itching, seizures, and hallucinations.

Resources:

Tips for Teens: Methamphetamine
Tips for Teens: Cocaine
National Institute on Drug Abuse

More SAMHSA publications on substance use prevention and treatment.

Last Updated: 03/22/2023

How do depression and anger interact?

Anger arises from a sense of threat to our emotional or physical well-being. It is also a reaction to, and often a distraction from, other negative emotions and the associated physical stress. Anger makes us direct our attention outward. Thus, it can be seen as a buffer against depression and the feelings and thoughts associated with it.

Symptoms of depression

Clinical depression is defined as a depressed mood accompanied by symptoms such as:

- Insomnia or persistent sleep;

- Feelings of worthlessness or inappropriate guilt;

- Significant unintentional weight loss or gain;

- Excitement or retardation of psychomotor development;

- Fatigue or loss of energy;

- Poor concentration or indecision;

- Recurring thoughts about death.

Anger is not listed as a symptom in the official guidelines for diagnosing depression. However, in recent years there has been an increase in research on the relationship between anger and depression. In particular, some studies have shown that anger can be a mask for depression.

Depression as inward anger

Psychoanalytically, depression has much to do with inward anger. This is an accurate estimate for many people. Heightened self-criticism, a deep sense of shame, and the accompanying feelings of hopelessness and helplessness associated with depression can be seen as the consequences of intense and constant self-esteem, a flurry of self-directed anger over dissatisfaction with oneself. They are combined with the discomfort and even fears associated with directing anger towards its true sources.

Inward-turned anger is often the result of childhood neglect, physical or emotional abuse. Feeling like a helpless child, a person can be confused and overwhelmed by the emotions of strong experiences. Subsequently, he may blame himself for such treatment, since all his well-being depends on his parents. This contributes to a predisposition to not feeling “good enough.”

Of course, other experiences both in adulthood and in adult life can trigger depression. This can be significant loss and injury. However, the intensity of their impact can also be reduced by the degree to which previous experiences have contributed to emotional and mental stability.

Anger as a result of depression

Anger can be a result of depression, the result of frustration, hopelessness and irritability associated with depression. This trend is not mutually exclusive in that underlying depression may reflect inward anger.

The relationship between depression and anger is complex. The more accurately we can identify the details of this association, the more accurately we can diagnose and treat both anger and depression.

Research on the association between depression and anger

Research is increasingly looking at defining a specific association between depression and anger. In one study, 293 outpatients diagnosed with depression were assessed over a period of time to determine the extent to which irritability predicted temper tantrums. Although they may occur with or without aggression, this study looked at only those tantrums that were aggressive in nature. Questionnaires conducted showed that those who scored high in irritability had significantly more temper tantrums.

Another study attempted to better define the factors that contributed to the association between anger and depression. A group of 88 patients with major depressive disorder was assessed using the Beck Depression Inventory (BDI), the Multivariate Anger Inventory (MAI), the Cognitive Emotion Regulation Inventory (CERQ), and the Anger Scale (ARS). The researchers concluded that problems with emotional regulation and ruminating about anger are key to the association of anger with depression.

Anger is not considered a mental disorder. However, it has been found to be present in a variety of psychological disorders, including emotional, anxiety, and depressive disorders. One review of this association highlights that, in general, anger is increased in these emotional disorders. However, more importantly for treatment, the study concludes that when anger is present, it is associated with greater symptom severity and worse response to treatment.

Much of our emotional suffering comes from judging our feelings. We may experience anger or sadness due to feelings of depression, anxiety due to anger, or depression and anger due to the presence of shame, and so on. These emotional responses to our emotions are often referred to as meta-emotions. In fact, much of the clinical work is focused on helping people become more self-compassionate, which includes developing the ability to recognize and accept the full range of emotions that are part of being human.

One study assessed the presence of anger and irritability in 536 people diagnosed with a major unipolar depressive episode. Frank irritability and anger were present in 292 participants. In addition, overt irritability and anger were associated with a significant increase in the severity of the depressive state, longer duration of the depressive episode, poorer impulse control, more chronic and severe long-term course of the disease, higher rates of lifetime comorbid substance abuse and anxiety disorder, more antisocial personality disorder, greater psychological impairment, decreased life satisfaction, and higher rates of bipolar disorder among relatives.

Conclusion

Research and clinical observations have confirmed the relationship between depression and anger. So, whether a person is self-medicating or seeking professional services for depression or anger, getting the details of that connection right is critical to improving well-being.

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Why am I so angry. Or about the connection between depression and anger - Galina Gadzhieva on vc.ru

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Are people around you starting to notice your changes? And they are by no means for the better? As Freud said, "Depression is anger turned inward." We think of depression as a loss of interest in everything, impotence, sadness, fatigue, feelings of hopelessness and loneliness. And several studies have shown that anger and depression are also directly related. Anger can occur as a result of malfunctions, chemical imbalances in the brain. You may experience outbursts of anger over the smallest of things. If you live and struggle with depression for months, or even years, it becomes more difficult to cope with each day and this also leads to a general feeling of dissatisfaction and anger.

Adolescents are often very irritable and even angry when they are depressed. In adolescents, depression manifests itself a little differently, and we may not notice it, attributing everything to hormonal changes.
Each of us has separate triggers that trigger these reactions of irritability and anger. Or events that can trigger such reactions, such as financial problems, work difficulties, conflict, stress, loss of loved ones, past trauma, or substance abuse.
Depression does not choose. It can affect both young and old, and men and women.
When we get angry and annoyed, then various thoughts arise in our head, and most often, they are not at all useful. We have every chance to beat depression, but until we figure out “our inner voice”, changes will occur slowly.
I'm not talking about hallucinations. I mean the internal dialogue that each of us leads with ourselves. Thoughts alone can already cause feelings of anger, hopelessness, loss, sadness, and depression. This inner voice can convince a person that he is pathetic, useless, good for nothing, that he is not loved, and that he is worthless.
And so says your disorder! You should take the time to sort out your thoughts. Learn to love and appreciate yourself.
When we are angry, aggressive, depression takes over. However, if we learn to track such moments and see the mistakes of our thinking, then every day we will be stronger in the face of depression. She will start to retreat.
It's not as easy as I write here, but it's possible. And I see this in my patients.
We are so used to living with our inner critic and negative thoughts that we cannot even admit that a positive view of the world can somehow help us. We think it's useless and ridiculous. However, having learned to notice and record the good facts from our lives, we confidently follow the path of freedom from anger and depression.
Depression changes us
Depression makes us different, and that's a fact. When it reaches a peak, then we are not able to do elementary things. Lack of sleep, irritability, feelings of sadness, guilt, lack of interest, joy. A person cannot take care of himself, in the most severe cases, hospitalization is necessary.
One of my patients compared her depression to a big black dog that follows everywhere and dictates the rules.
And this further exacerbates our anger. Everything that you used to do with pleasure now brings a feeling of frustration. Your helplessness and the state itself begins to annoy you. You even begin to hate yourself. And everything that accumulates inside, one day will break out. An outburst of anger and hatred.
Also, you can analyze and understand how much you are missing because of your condition, and this does not cause positive emotions. And it exacerbates the problems and leads to even greater hostility, self-hatred.
Anger can be different
Adaptive anger is the one that pushes us to positive changes. Encourages you to look for a way out, to do everything possible to defeat anger. You understand the reason and know how to deal with it. Apply, for example, breathing practices, or sports.
This anger promotes growth and allows you to become the best version of yourself.
Maladaptive anger - destructive and harmful to mental health. It is directed towards us. On themselves. We punish ourselves and hate ourselves. All this leads to a decrease in self-esteem and self-confidence. This kind of anger makes us feel worse and worse every day.
How we deal with anger is influenced by many factors—our upbringing, learned responses, past traumatic events, rules, religion, and other factors.
If you find yourself in anger, and are increasingly faced with similar situations, it may be due to depression.
To check and confirm this, it is worth contacting a psychologist or psychotherapist.
Depression and disappointment
Depression can very well disguise itself as different conditions.