If you are experiencing depression for the first time, you may wonder what to expect. Clearly, you will have a lot of days when you are feeling down, lonely, and even sorrowful. But, can it make you violent? Many teens are probably wondering about all the possible feelings and behaviors they can expect when diagnosed with depression.

There is certainly a level of frustration experienced with depression. Whether that leads to anger and aggression depends on the coping skills of the teen. How is your self-control? Can you manage your frustration and anger in a healthy way? Or do you sometimes just want to go outside and break sticks over your legs?

Most cases violence associated with depression are also associated with another mental health disorder. For example, many times, people with bi-polar disorder can get violent during a depressive state. Or patients with a history of acting out have depression along with anxiety or borderline personality disorder.

The research is far from demonstrating a causal link between depression and violence, but doctors and scientists have confirmed that violent episodes can occur during a depressive state of another comorbid disorder, in combination with anger or rage, or during occurrences of emotional dysregulation.

Comorbidities

People with mental illness may be at a higher risk of experiencing multiple forms of violence. Recent mental health studies suggest that patients have experienced three forms of violence: self-harm, harming others, and being harmed by others. Over half of patients experience at least one form of violence, a quarter experience at least two forms, and around 7% experience all three.

Scientists discovered that there are relationships among depression, other mental health issues, and drug use. Teens with depression and other comorbidities tend to self-medicate depression with drugs or alcohol, and those substances may increase depression, frustration, and anger. All of these can lead to some form of violence when the teen can no longer handle the emotions.

Although depression has been identified in some studies as a contributing factor in cases of violent episodes, that does not mean people who have depression are dangerous. The characteristics of certain mental illnesses, when combined with depression, may make a teen more likely to become violent.

When people with depression commit a crime, mental illness is not always the only contributing factor. Typically, it’s a combination of risk factors, such as drug or alcohol use, stress from poverty, domestic violence in childhood, and/or experiencing domestic violence, that make a teen with depression feel that violence is the only option.

The frustrations of living with depression as well as another mental illness or substance abuse, can lead to violence as an outburst of emotions that haven’t been dealt with or that the teen is unable to control. But the key emotion that combines with depression to create the potential for violence is anger.

Anger and Depression

Teens who have anger and depression may try to suppress their anger. They don’t want to seem out of control. Conversely, they are more likely to display their anger through violence. What tends to happen is that anger builds up until it must be released – and the teen with depression cannot always control when that release happens or who it may be directed toward.

Doctors suggest that there are triggers that each person has that can lead to a violent episode. It’s essential for teens to identify those triggers and learn to avoid them. A teen’s doctor might suggest that lifestyle changes can ease the anger. Reducing the amounts of sugar and caffeine ingested may be a good start. Teens can also consider going outside for fresh air or taking a walk or bike ride to clear the mind.

But, when a teen is angry continuously for two weeks or more, it’s time to see your mental health therapist. They can work with teens on managing and understanding anger, as well as depression. If your depression is chronic, your doctor can prescribe medication. “You may have to try several medications or dosages before finding a treatment that works for you. Be patient and don’t stop taking medication without first discussing it with your doctor.”

There is also a phenomenon known as maladaptive anger. Maladaptive anger affects a teen negatively. This type of anger can contribute to the teen feeling victimized, sulky, or trapped in a feeling of being wronged. If maladaptive anger is turned inward, it can lead a teen to feel overly critical toward themselves, self-hatred, or continually hearing negative self-talk that calls them powerless, hopeless, pathetic, or helpless. That critical inner voice is at the root of maladaptive anger, leaving the teen in a state of frustration and suffering. It is only a matter of time before violence becomes an outlet.

Researchers have also found that irritability and anger in teen depression patients was associated with severe depression and chronic depression. Irritability and anger were associated with poor impulse control, higher rates of substance abuse, anxiety disorder, antisocial personality disorders, and diminished life satisfaction. The poor impulse control is the key to violent acting out by teens with depression.

But, there is another feature to mental health issues that can lead to violent acting out, and that is emotional dysregulation.

Emotional Dysregulation

Emotion Dysregulation may be thought of as “the inability to manage the intensity and duration of negative emotions such as fear, sadness, or anger.” For the teen battling poor emotion regulation, any negative situation can create strong emotions that are tough to recover from. Prolonged negative emotion can lead to physical, emotional, and behavioral acting out.

For instance, a simple argument with a friend may cause a blatant over-reaction that leads to rumination. The teen feels powerless to control how he or she feels. This can escalate to a conflict that creates further stress for teen and others. Teens with emotion dysregulation have great difficulty maintaining interpersonal relationships. They tend to have extreme emotional reactions and can’t seem to resolve conflicts; this adds stress to personal relationships.

Some causes of emotional dysregulation can be childhood trauma, neglect, and traumatic brain injury. Humans are predisposed to emotional reactivity that can be exacerbated by chronic invalidation of their existence in their environments resulting in emotional dysregulation. Emotional dysregulation can easily be missed in individuals diagnosed with depression. Look for the signs of emotional dysregulation in your teen if he or she seems to have violent outbursts:

• Severe depression or anxiety
• High levels of shame and anger
• Self-harm, such as cutting
• Substance abuse
• Risky behaviors
• Extreme perfectionism
• Can’t maintain interpersonal relationships
• Disordered eating
• Suicidal ideation or attempts

Emotion dysregulation is believed to present and may reflect “internalized failures of emotion management, while the externalized behaviors such as aggression, alcohol and substance abuse, disordered eating, self-harm, and suicidality associated with emotion dysregulation may represent, in part, efforts to escape emotions experienced as overwhelming or intolerable.”

Widespread literature exists on the relationship between depressive symptoms and violent behavior in adolescents. One study reported that depressive symptoms assessed at the outset of their study were a predictor of violent behavior in young teens. That, combined with a diagnosis of emotional dysregulation will present with persistent irritability and frequent episodes of extreme behavior, including violent behavior.

Irritability and anger are prominent in emotional dysregulation of adolescents, particularly when the teen demonstrates episodes of extreme behavioral dyscontrol, including violence. It’s been found that teens with depression are less able to control their expression of anger, which leads to violence on some occasions.

Emotional dysregulation can be a prominent factor in depressed teens acting out violently. If a teen is acting out regularly, it’s important to have the teen assessed.

Assessment

To assess the risk of violence in people with depressive symptoms, we must consider the comorbidities where these symptoms exist. “Depressive symptoms may occur in MDD, bipolar disorder, or schizophrenia. They may also occur in dementia, PTSD, or personality disorder. The assessment and treatment of the underlying disorder is important. We must also consider that this association between aggression and depressive symptoms is further modified by various demographic and historical factors.”

Patients who present with depression must be assessed not only for suicidal ideation and suicidal potential, but the risk of violence as well. Assessment of a depressed teen’s potential for violence considers a history of violence, substance abuse, childhood trauma, and poor impulse control.

Highly publicized acts of violence by people with mental illness is about more than just public perception. Therapists and doctors must assess their patients for potential violence. While a clinician may make a general assessment of relative risk, it is impossible to predict specific acts of violence since they are predicated on the teen’s emotional state.

If a teen has acted violently before, they are more likely to become violent again. Research suggests that this may be the largest single predictor of future violence. However, these studies cannot determine whether past violence was due to mental illness or other factors.

Teens who are depressed and engage in substance use are far more likely to become violent than a teen with just a diagnosis of depression. A comprehensive assessment includes questions about substance use for this very reason. Teens with depression who abuse drugs or alcohol are less likely to follow their treatment plan, which can make psychiatric symptoms even worse.

Research has found that teens are more likely than adults to act violently. Their level of maturity and the current growth state of the brain are keys to their inability to control their anger or frustration, which can lead to violence. Teens are also under an unusual level of social stress. If a teen is homeless, or has other social stressors, violence can be an issue.

If a teen has been the victim of a violent crime or has experienced domestic violence, a mental health clinician can expect that violent acting out could be a symptom. Assessment of the teen is crucial to ensure that a proper treatment plan is put into place.

Treatment

Both violent acting out and symptoms of depression must be considered when planning treatment. Depressive symptoms are an important predictor of treatment response. A recent study suggests that extent of depression can predict the extent of physical aggression when various medications are prescribed. The drugs olanzapine and clozapine for teens with depression created a significant decrease in aggression.

Olanzapine and clozapine act to balance the levels of serotonin in the brain. Long-term treatment with clozapine and olanzapine has been linked to the normalization of serotonin in the brain, which leads to fewer episodes of aggression or violence in teen depression patients.

Medications and psychotherapy are effective for most teens with depression. A primary care physician or licensed psychiatrist can prescribe medications, but most teens with depression also benefit from seeing a mental health professional, such as a counselor or therapist.

The goal of treatment is to normalize the biological imbalance of the chemicals in the teen’s brain as well as giving the teen the chance to explore his or her emotions and what has created their anger and frustration. Medication helps with the brain, and therapy helps by letting the teen talk about their condition and symptoms.

Different types of psychotherapy can be effective for depression, including cognitive behavioral therapy or interpersonal therapy. According to the Mayo Clinic, psychotherapy can help a teen

• Adjust to a crisis or other current difficulty
• Identify negative beliefs and behaviors and replace them
• Explore relationships and experiences, and develop positive interactions with others
• Find new coping skills and problem solving strategies
• Identify triggers that contribute to depression and avoid them
• Regain a sense of satisfaction and control in your life
• Learn to set realistic goals
• Develop the ability to tolerate and accept distress using healthier coping skills

Treatment is the best way to help a teen overcome their physical, aggressive outbursts and lessen the probability of a violent action.

Conclusion

Depression and violence have been linked by science. Studies suggest that comorbidities, substance abuse, and other factors in conjunction with depression will increase the chance of a violent outburst. It is essential that your teen have an assessment and receives treatment here at a facility like Beachside before someone is hurt.