Skip to main content Accessibility help

Anger and depression

  • Fredric N. Busch


A series of psychoanalytic theorists and clinicians have suggested that conflicts about anger play a central role in the development of depression. Research data have supported the notion that patients struggle with the experience and expression of angry feelings. Anger in people with depression often stems from narcissistic vulnerability, a sensitivity to perceived or actual loss or rejection. These angry reactions cause intrapsychic conflicts through the onset of guilt and the fear that angry feelings will disrupt relationships. These conflicts lead to anger being directed inwards, further lowering self-esteem, creating a vicious cycle. Defence mechanisms that are triggered, including passive aggression, reaction formation, denial and identification with the aggressor, are ineffective at managing these conflicts and further prevent the appropriate expression of anger. This article discusses how to identify and detoxify angry feelings and fantasies using a psychodynamic approach.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Anger and depression
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Anger and depression
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Anger and depression
      Available formats


Corresponding author

Dr Fredric N. Busch, 10 East 78th Street, New York, NY 10075, USA. Email:


Hide All

Declaration of Interest




Hide All
Abbass, AA, Hancock, JT, Henderson, J et al (2006) Short-term psychodynamic psychotherapies for common mental disorders. Cochrane Database of Systematic Reviews; 4: CD004687.
Abraham, K (1911) Notes on the psycho-analytical investigation and treatment of manic-depressie insanity and allied conditions. In Selected Papers on Psychoanalysis, 137–56. Hogarth Press, 1927.
Abraham, K (1924) A short study of the development of the libido, viewed in the light of mental disorders. In Selected Papers on Psychoanalysis, 418501. Hogarth Press, 1927.
Becker, EW, Lesiak, WJ (1977) Feelings of hostility and personal control as related to depression. Journal of Clinical Psychology; 33: 654–7.
Bloch, AL, Shear, MK, Markowitz, JC et al (1993) An empirical study of defense mechanisms in dysthymia. American Journal of Psychiatry; 150: 1194–8.
Brenner, C (1975) Affects and psychic conflict. Psychoanalytic Quarterly; 44: 128.
Brenner, C (1979) Depressive affect, anxiety and psychic conflict in the phallic-oedipal phase. Psychoanalytic Quarterly; 48: 177–97.
Brody, CD, Haaga, DAF, Kirk, L et al (1999) Experiences of anger in people who have recovered from depression and never-depressed people. Journal of Nervous and Mental Disease; 187: 400–5.
Busch, FN, Rudden, M, Shapiro, T (2004) Psychodynamic Treatment of Depression. American Psychiatric Press.
Churchill, T, Hunot, V, Corney, R et al (2001) A systematic review of controlled trials of the effectiveness and cost-effectiveness of brief psychological treatments for depression. Health Technology Assessment; 35: 1173.
Fava, M, Rosenbaum, JF, Pava, JA et al (1993) Anger attacks in unipolar depression, Part 1: Clinical correlates and response to fluoxetine treatment. American Journal of Psychiatry; 150: 1158–63.
Feldbau-Kohn, S, Heyman, RE, O'Leary, K (1998) Major depressive disorder and depressive symptomatology as predictors of husband to wife physical aggression. Violence and Victims; 13: 347–60.
Freud, S (1917) Mourning and melancholia. In The Standard Edition of the Complete Psychological Works of Sigmund Freud, Volume 14 (ed Strachey, J) 239–58. Hogarth Press, 1953.
Gabbard, GO (2000) Psychodynamic Psychiatry in Clinical Practice (3rd edn). American Psychiatric Press.
Goldman, L, Haaga, DAF (1995) Depression and the experience and expression of anger in marital and other relationships. Journal of Nervous and Mental Disease; 183: 505–9.
Jacobson, E (1954) Transference problems in the psychoanalytic treatment of severely depressed patients. Journal of the American Psychoanalytic Association; 2: 695705.
Jacobson, E (1971) Depression: Comparative Studies of Normal, Neurotic, and Psychotic Conditions. International Universities Press.
Jacobson, E (1975) The psychoanalytic treatment of depressive patients. In Depression and Human Existence (ed Anthony, B) 431–43. Little, Brown & Co.
Klein, M (1935) A contribution to the psychogenesis of manic depressive states. International Journal of Psychoanalysis; 16: 145–74.
Klein, M (1940) Mourning and its relation to manic-depressive states, in love. In Guilt and Reparation and Other Works 1921–1945, 344–69. Free Press, 1975.
Knekt, P, Lindfors, O, Harkanen, T et al (2008) Randomized trial on the effectiveness of long-and short-term psychodynamic psychotherapy and solution-focused therapy on psychiatric symptoms during a 3-year follow-up. Psychological Medicine; 38: 689703.
Koh, KB, Kim, CH, Park, JK (2002) Predominance of anger in depressive disorders compared with anxiety disorders and somatoform disorders. Journal of Clinical Psychiatry; 63: 486–92.
Kuyken, W, Watkins, E, Beck, AT (2005) Cognitive–behaviour therapy for mood disorders. In Oxford Textbook of Psychotherapy (eds Gabbard, GO, Beck, JS, Holmes, J) 111–26. Oxford University Press.
Leichsenring, F (2001) Comparative effects of short-term psychodynamic psychotherapy and cognitive-behavioural therapy in depression: a meta-analytic approach. Clinical Psychology Review; 21: 401–19.
Luutonen, S (2007) Anger and depression – theoretical and clinical considerations. Nordic Journal of Psychiatry; 61: 246–51.
Milrod, BL, Busch, FN, Cooper, AM et al (1997) Manual of Panic-Focused Psychodynamic Psychotherapy. American Psychiatric Press.
Milrod, B, Leon, AC, Busch, FN et al (2007) A randomized controlled clinical trial of psychoanalytic psychotherapy for panic disorder. American Journal of Psychiatry; 164: 265–72.
Pan, H, Neidig, P, O'Leary, D (1994) Predicting mild to severe husband to wife physical aggression. Journal of Consulting and Clinical Psychology; 62: 975–81.
Rado, S (1928) The problem of melancholia. International Journal of Psychoanalysis; 9: 420–38.
Rudden, MG, Busch, FN, Milrod, BL et al (2003) Panic disorder and depression: a psychodynamic exploration of comorbidity. International Journal of Psychoanalysis; 84: 9971015.
Schless, AP, Mendels, J, Kipperman, A et al (1974) Depression and hostility. Journal of Nervous Mental Disease; 159: 91100.
Schuyler, D (2003) Cognitive therapy for depression. Primary Psychiatry; 10: 33–6.
Swanson, JW, Holzer, CE, Ganju, VK et al (1990) Violence and psychiatric disorder in the community: evidence from the Epidemiologic Catchment Area surveys. Hospital and Community Psychiatry; 41: 6170.
Wolfersdorf, M, Kiefer, A (1998) Depression and aggression. A control group study on the aggression hypothesis in depressive disorders based on the Buss Durkee Questionnaire. Psychiatrische Praxis; 25: 240–5.


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Anger and depression

  • Fredric N. Busch
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *