Identifying Irritability—What’s Causing Angry Outbursts in Rational Adults?

Posted by Medical Board on May 30, 2018 in Men Women
Identifying Irritability—What’s Causing Angry Outbursts in Rational Adults?

Occasional irritability is a normal response to stressful stimuli and situations. A poor night’s sleep, hunger, or being trapped in an uncomfortable situation for which you have no control can foster irritability in even the calmest, most easygoing of individuals.

Frequent or chronic irritability however, may cause interpersonal conflicts, or be an indicator of an underlying medical or mental health condition.[1]

Who Gets Irritable and Why?

Irritability in Women with PMS or PMDD

Premenstrual Syndrome (PMS) affects at minimum, 20% to 30% of women of childbearing age.[3] Some studies put that number closer to 75%.[2]

Feelings of sadness, anxiety, and irritability present about one week prior to menstruation. Shortly after menstruation begins, these symptoms generally subside and disappear altogether. The cause of PMS appears to be related to the rise and fall of progesterone levels and its effects on the amygdala, part of the brain that involves processing emotion.

Premenstrual Dysphoric Disorder (PMDD)

About 1 in 20 women suffer with premenstrual symptoms so severe that personal relationships and everyday activities such as, work or school may be adversely affected. In the case of PMDD, 5 mood, behavioral or physical symptoms must be present for a period of 4 days prior to menstruation. One of these must involve mood.

Understanding the neurobiology behind these disorders is key to finding treatment for many of the symptoms including, irritability.[3]

Irritability can be defined as a state of impatience marked by psychological tension and anger, as well as the loss of control over temper, and heightened sensitivity to outside stimuli.

In terms of female-specific mood disorders, irritability plays a significant role in PMS/PMDD. In fact, in one cross-national study involving over 1000 American and European women, anger and irritability was noted in 80% of respondents who suffered PMS.[2]

Irritability in Menopause and Genetics

Up to 70% of women cited irritability as the chief complaint associated with perimenopause. This is a period of great hormonal fluctuation before a woman’s final menstrual period.[2]

While researchers know that gonadal steroids impact the many neuromodulator processes including serotonin and norepinephrine that affect mood it is still unclear just how reproductive hormones play a role in irritability and depression in some women during the menopausal transition. Some preliminary studies however, suggest a possible link between selected estrogen-related single nucleotide polymorphisms (DNA building blocks) based on 3 inherited genes. These appear to be associated with increased depressed mood, as scores on the CES-D, Center for Epidemiological Studies Depression Scale indicate. Depression and irritability are often comorbidities during the menopause transition.[2]

Irritable Male Syndrome

Irritable male syndrome (IMS) describes a collection of symptoms that include nervousness, irritability, depression and lethargic affect in adult males. This occurs in men in the absence of testosterone. Changes in the brain’s hypothalamus involving important neurotransmitters that help modulate mood, including serotonin and dopamine are likely to blame for IMS. Neuroscientists believe that the withdrawal of opioid peptides trigger low hypothalamic amine levels during this period of transition in midlife.[4]

Sleep Deprivation and Irritability

Most people know that a lack of sleep directly affects mood. After a restless night spent tossing and turning, we may feel short-tempered, irritable, and more vulnerable to stress. According to a University of Pennsylvania study, participants who were allowed just 4.5 hours of sleep per night for one week reported feeling more angry and sad, stressed, and mentally exhausted than those who slept a full 8 hours.

Once normal sleep patterns were restored however, mood improved significantly. This is further supported by a number of studies that have found 15% to 20% of people with a clinical diagnosis of insomnia will develop a major depressive disorder.

In one major study of 10,000 adults, individuals with insomnia were 20 times more likely to develop an anxiety disorder. Irritability is classified as such.[6]

Irritability and Poor Nutrition

Nutrition is an important part of brain function, and ultimately mood. The field of nutritional psychiatry is an emerging area of study with many possible applications. Nutrients are necessary to not only nourish the brain, but to help protect it from oxidative stress and the free radicals produced as a by-product of oxygen use.

The brain, a powerful organ does an amazing job at regulating many of the body’s processes. It is however, vulnerable to a number of conditions that affect mood. A diet high in refined sugars for example, not only causes problems with insulin regulation, but also promotes inflammation and oxidative stress throughout the body. Many studies also support the connection between sugar and brain dysfunction, citing an elevation in depressive symptoms and negative mood shortly after high consumption.

Gut Health and Irritability

The foods we eat really do impact how we feel and the way in which mood is regulated. Consider this. The neurotransmitter, serotonin is not only responsible for modulating sleep, appetite, and pain, but also mood. Since 95% of serotonin is produced in the gastrointestinal tract and 100 million nerve cells line the walls, “good bacteria” becomes very important to the microbiome. Good bacteria help protect the gut against inflammation and the many toxins created by “bad bacteria”. This promotes greater nutrient absorption and helps support neural pathways between the intestines and the brain.

Multiple studies support the ability of probiotics that control the production of bad bacteria, to improve mental health through the healing of the intestinal tract. In fact, studies have shown that those who eat a typical Western diet, high in sugar, preservatives and chemicals are 25% to 35% more likely to suffer from depression than individuals who eat a more traditional Mediterranean diet or Japanese diet. These include fewer processed grains, more fermented foods, and seafood, fresh fruits and vegetables, and less dairy.[5]

Treatment for Irritability

A broad range of treatment options are available to help alleviate irritability.

Pharmaceuticals

Specific medications can be prescribed by your doctor to decrease or eliminate symptoms of irritability.

These include:

Paroxetine—This medication targets serotonin in the brain with specific attention to the role it plays in social dominance and associated behavior, involving irritability in social situations.

Venlafaxine—Classified as a norepinephrine and serotonin reuptake inhibitor, venlafaxine has been successful in treatment of generalized anxiety disorder, which often involves irritability.

Imipramine—This medication is a tricyclic antidepressant and not usually first thought of as a treatment for irritability. It is often used as a back-up defense for anxiety and depression however, when other medications fail to work effectively.

Sertraline—This selective serotonin reuptake inhibitor was initially prescribed for anxiety, both with and without depression. This medication is considered the safest for adolescents and pregnant mothers.

Natural Treatment for Irritability

Environmental factors involving built-up toxins in the body and brain may also contribute to irritability in some individuals. By rectifying certain nutritional deficiencies, symptoms of irritability may decrease or be eliminated altogether.

B Vitamins—B vitamin deficiencies may be responsible for a number of stress related conditions including irritability and anger control issues. Levels of the amino acid, homocysteine often rise in the absence of B vitamins. Higher levels promote negative emotions such as irritability, anger, and anxiety. Supplementing with Niacin (B3) may help alleviate irritability symptoms.

Magnesium—This mineral tends to have a calming effect on individuals and can help promote relaxation. Magnesium helps support more than 300 enzymatic reactions including the transfer of nerve impulses. Supplementing with magnesium can contribute to the restoration of mental health and positive mood.

Unsulphured black strap molasses (BSM)—This contains essential vitamins A, B, C, & E and can be taken by mouth, daily. Unsulphured Black Strap Molasses help support mood and brain function.

Himalayan Pink Rock Salt—Himalayan pink crystal salt contains more than 80 essential minerals (some of which support mood) and can be used in place of iodized salt in many recipes and food preparations.

Liver Detox—The liver works hard to filter toxins and chemicals from the body. In order to support maximum function, a liver cleanse is recommended for individuals who may be suffering from oxidative stress. Herbs and spices including garlic, ginger, turmeric, cinnamon, milk thistle, dandelion, artichoke, and chicory root work in the liver as natural detoxifiers.

In addition to diet supplementation, it is important to limit the following for optimal mental health:

  • Artificial sweeteners
  • Refined flour and sugar
  • Highly processed and prepackaged foods
  • Alcohol
  • Fast-food

Practice one or more of the following regularly, to promote positive mental health as well:

  • Deep relaxation
  • Meditation
  • Tai Chi
  • Chi gong
  • Biofeedback
  • Regular exercise or walking

While irritability is a natural reaction to a stressful environment or temporary situation, it is important to address issues of chronic or frequent irritability. With proper medical intervention and healthy lifestyle choices, many individuals will reverse the negative effects of this anxiety-related mindset or condition.

References

1Barata, Paula C., et al. Advances in Pediatrics., U.S. National Library of Medicine, 8 Apr. 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC4848029/.
2Born, Leslie, et al. Advances in Pediatrics., U.S. National Library of Medicine, July 2008, www.ncbi.nlm.nih.gov/pmc/articles/PMC2440789/.
3Hantsoo, Dr. Liisa, et al. “What Are PMS and PMDD?” PMS/PMDD Study, Perelman School of Medicine, University of Pennsylvania, www.med.upenn.edu/pmsstudy/pms-pmdd.html.
4Lincoln, G A. “The Irritable Male Syndrome.” Advances in Pediatrics., U.S. National Library of Medicine, www.ncbi.nlm.nih.gov/pubmed/11999307.
5Selhub, Eva. “Nutritional Psychiatry: Your Brain on Food.” Harvard Health Blog, 5 Apr. 2018, www.health.harvard.edu/blog/nutritional-psychiatry-your-brain-on-food-201511168626.
6“Sleep and Mood.” Sleep and Memory | Need Sleep, healthysleep.med.harvard.edu/need-sleep/whats-in-it-for-you/mood.

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