The problem with misidentifying an angry person as depressed is that the treatment for clinical depression is not benign.
The drugs used to treat depression can interact with other drugs, can lead to symptoms (side effects) of their own, and are not inexpensive. More importantly, antidepressants are not a solution to anger.
Aggravating a patient whose pain complaints are minimized may result in a constellation of symptoms that at once appear to be both anger and depression. Being in pain often results in dependency upon whomever can provide relief.
This reliance upon others is sometimes referred to as “hostile dependency.” Interestingly, this is also seen in teenagers who seek to, but cannot really afford to, be independent.
So, let us assume that the patient is quite angry. In both depression and anger, the individual is sullen, often withdrawn and brooding, restless and agitated, and likely no one wants to listen to what seems like endless complaining.
Whether a clinician or counselor, someone needs to spend time differentiating (and helping the patient separate) between anger and depression. Anger can be resolved with reassurance that amends will now be made. Depression, by contrast, requires treatment.
Comorbidity (co-existing) conditions are not uncommon with PTSD and frequently include depression and other clinical disorders. The oppressive symptoms of PTSD feel inescapable to the patient who may self-medicates with alcohol or other drugs which they secure from doctors or from the street.
The co-occurrence of PTSD and substance use is a major public health concern. It is very easy, and somewhat naive, to believe that a patient with PTSD knows immediately how to curb the intake of drugs and alcohol. The patient sees these agents as temporarily lowering apprehension, anticipation, fear, worry and alarm. Doctors become reluctant to address the PTSD symptoms, fearing they will increase the anxiety and, thereby, the substance abuse. Conversely, others fear that if they address the substance abuse, then the patient has no viable means to combat the symptoms of the PTSD. Both positions are inaccurate. The reality is that the addictive behaviors and the anxiety behaviors must be addressed at the same time.
Alexithymic individuals (males more than females) cannot express their feelings verbally. They either act them out (destructively) or hold them in (intrapunitive and equally destructive).
These alexithymic individuals are more prone to develop somatic symptom (formerly somatoform) disorders (excess focus upon bodily complaints). They are also more prone to psychophysiologic – physical – destruction arising from psychological) disorders.
Although a challenge, it is possible to psychologically examine these patients and analyze this pervasive pattern of inability to healthily express emotions.
Family members will often refer the person having this problem. For many of these patients, their bodily focus will decrease when they have the opportunity to discover what they truly feel and how to appropriately deal with these feelings.