What triggers homicidal thoughts during depression

In this article, we will explain what triggers homicidal thoughts during depression. 

Violence is not generally believed to be associated with depression, but in many different disorders, results indicate a correlation between violent activity and depression or depressive symptoms. A Swedish study compared the criminal records of 47,158 depressed individuals with the records of 898,454 individuals matched by age and gender with no history of depression. Those in the depressed community were about 3 times more likely to commit violent crimes, such as murder, attempted homicide, aggravated assault, or burglary than the general population.

Also when past patterns of abuse, self-harm, psychosis, and drug use were taken into account, this correlation remained present. Also, the risk of violent crime in people with more depressive symptoms has risen dramatically.

What triggers homicidal thoughts during depression

Here are some of the triggers that lead to homicidal thoughts during depression:

• Anger
• Irritability
• Emotional dysregulation
• Impulsivity
• Neurophysiological factors
• Serotonergic deficiency
• Impairment of prefrontal cortex

Anger

We might be missing other negative feelings that are closely related to depression if we concentrate on the depressed mood. A simple demarcation between different emotions does not always exist. Depressed people, besides being depressed, often feel disgruntled, resentful, or irritable. In individuals who are predisposed to such actions, such emotions can lead to violence, especially when faced with extreme frustration. In subjects with depressive symptoms, multiple studies suggest that mood states other than depression, such as irritability and rage, occur. These signs tend to be clinical markers for a considerably more complicated, persistent, and extreme type of MDD when irritability and rage are present during an episode of major depression. Increased depressive severity, poorer impulse control, and a history of drug abuse are more likely for patients. Violence is made more likely by the presence of a drug abuse disorder and weak impulse control.

Both depression and aggression have been associated with rage. In males and children or teenagers, this correlation is more frequently present. Depressed males are less likely or mindful of these emotions to have clear depressed feelings; instead, they have increased irritability and rage, which may result in aggression.

We need to understand the underlying condition in which these symptoms occur as we evaluate the risk of aggression in people with depressive symptoms.

Irritability

In mood disorders of children and adolescents, particularly males, irritability and anger are prominently present, especially in the mood dysregulation disorder in which episodes of severe behavioral dyscontrol, including aggression, are frequent. Besides, children and adolescents with depression are less capable of regulating their anger expression, which can then lead to aggression. For example, evidence indicates that depressed children have more difficulties than non-depressed children in retaining cognitive control over their frustration. The connection between depression and violence may either be mediated by frustration, or partially mediated.

Emotional dysregulation

While there is a greater intuitive appeal to the relationship between anger and violence than that between depression and violence, there may be a more general relationship between strong emotional states or faulty emotional control, including depression and violence, particularly impulsive violence. When they are emotionally activated, whether by anger or depression, aggressive impulses are more likely to result in violence.

Impulsivity

The strength of the underlying impulse that drives a person to action can be magnified by affective states, including rage and depression. The reflection in the decision-making process that would prevent intervention can also diminish certain states. In one study, it was more likely that impulsive subjects with depression were aggressive, while impulsive subjects that were not depressed did not differ from non-impulsive subjects.

In another study, clozapine, olanzapine, or haloperidol is randomized and followed for 12 weeks in aggressive patients with schizophrenia. There was more physical aggression over the subsequent 12 weeks in all 3 groups when extreme depression was present at baseline, and especially if it was accompanied by high impulsivity. Also in high-impulsivity patients, there was less physical aggression while there was low baseline depression.

Impulsivity in depressed individuals is often observed and correlates favorably with aggressive behavior. MDD patients display higher ratings of impulsivity and more extreme violence than controls. In patients with bipolar disorder, time-lagged models suggest that greater negative effects, including anxiety and depression, predict subsequent increases in impulsivity. Depressed mood tends to precede impulsivity. Impulsivity, although it is maladaptive, can be a mechanism for controlling negative effects.

Neurophysiological factors

From a biological viewpoint, the relationship between affective states, including depression, and aggression has been studied. Multiple biological factors were considered, but in the past 50 years, serotonergic activity has gained the most attention. The relation between reduced serotonin function and aggression is often mediated by regulation of the effect.

Serotonergic deficiency

Underlying serotonergic dysfunction has been linked to the strong relationship between depression and aggression. Patients with MDD and low 5-hydroxyindoleacetic acid (5-HIAA), the primary serotonin metabolite, were compared to those with major depression and normal levels of 5-HIAA. Patients with low 5-HIAA showed much greater hostility and aggression than patients with normal levels of 5-HIAA. Note that this relationship occurs and lacks nosological precision across various psychiatric conditions.

Impairment of prefrontal cortex

This disorder is likely to affect the prefrontal cortex, which is involved in executive function. It exerts a regulatory function and, including emotional feedback, reduces urges and other lower-level behavioral factors. A major serotonergic projection is received by the prefrontal cortex, which is important for this role. The development of aggressive actions can be responsible for the malfunction of the circuit involved in emotion control, which involves the prefrontal cortex, the amygdala, hippocampus, and other interconnected structures.

Psychotic Depression

A severe illness that needs prompt care and close supervision by a medical or mental health professional is psychotic depression, also known as a major depressive disorder with psychotic symptoms.

A common psychiatric illness that can have a detrimental effect on many aspects of someone’s life is a major depressive disorder. It influences mood and actions, including appetite and sleep, as well as different physical functions. Individuals with severe depression often lose interest in hobbies they once enjoyed and have difficulty conducting regular activities. They may also sometimes feel as if life is not worth living.

It is estimated that there are also signs of psychosis in about 20 percent of people with severe depression. Sometimes, this combination is known as psychotic disorder. However, in psychology, a major depressive disorder with psychotic characteristics is the more technical term. The circumstance causes people to see, hear, or believe stuff that is not true.

Assessment of homicidal thoughts during depression

We need to understand the underlying condition in which these symptoms occur as we evaluate the risk of aggression in people with depressive symptoms. With MDD, bipolar disorder, or schizophrenia, depressive symptoms can occur. Dementia, PTSD, or personality disorder can also occur in them. The diagnosis and treatment of the underlying condition are important. We must also note the different demographic and historical influences further change this correlation between hostility and depressive symptoms.

It is important not only to assess patients with depressive symptoms for suicidal ideation and suicidal potential, but also to evaluate the likelihood of violence directed at others.

Many risk factors, including a history of aggression, drug abuse, childhood trauma, and impulsiveness, are taken into account in determining the propensity of a depressed patient for violence. Once these variables are combined, the risk of violence is dramatically higher. For depressed patients who already had a history of violent crime and drug abuse or self-harm, the rates of violent crime were above 15 percent over a 3-year follow-up.

Treatment of homicidal thoughts during depression

Both pharmacological and cognitive-behavioral approaches are involved in treatment. Additional issues can also be dealt with, such as drug misuse. In high-risk communities, the combination of medication and psychosocial interventions may be especially important.

Medications

When making medical choices, the presence of depressive symptoms should be taken into account. In a double-blind, parallel-group analysis of clozapine, olanzapine, and haloperidol, depressive symptoms were a strong predictor of treatment response. Patients with high baseline depression who received olanzapine or clozapine had substantially less aggression than those with high baseline depression who received haloperidol, while baseline depression predicted the level of physical aggression in all 3 drug classes. A significant indicator of the differential response to antiaggression therapy was depression. This is most likely due to the dissimilar neurotransmitter profiles of the drugs.

Olanzapine and clozapine function as serotonin antagonists and long-term serotonin antagonist therapy can result in changes in serotonin binding sites that are compared qualitatively and quantitatively to those produced by serotonin agonists. Long-term clozapine therapy reduces the turnover of serotonin and improves its supply in the nucleus accumbens. The higher anti-aggressive effects of olanzapine and clozapine were correlated with their normalization of serotonergic activity.

Electroconvulsive therapy (ECT)

Some individuals with psychotic depression, like others, can not respond to medications. Electroconvulsive therapy (ECT) may be required in these cases to relieve symptoms. ECT, also known as electroshock therapy, has proved to be a safe, reliable treatment for individuals with symptoms of suicidal thoughts and psychotic depression. Electrical currents in measured quantities are sent through the brain during ECT, which is normally done by a psychiatrist. This causes a slight seizure, which affects the brain’s neurotransmitter levels. Usually, ECT is administered under general anesthesia in a hospital.

In this article, we explained what triggers homicidal thoughts during depression. 

FAQs: What triggers homicidal thoughts during depression

References

https://www.healthline.com/health/depression/psychotic-depression

https://www.psychiatrictimes.com/view/depressive-symptoms-associated-aggression

https://www.verywellmind.com/is-depression-linked-to-violence-1067393