As Mean as a Rattlesnake!

Not long ago, a mother was sharing with me her frustrations about her teenage daughter’s behavior.  The girl was rude.  She was disrespectful.  She was argumentative.  As the mother talked, she became louder and more animated until eventually she screamed out “She’s as mean as a rattlesnake!!!” 

When I visited with the daughter, I discovered that she had been feeling bad for some time.  She wept in my office about many concerns and frustrations.  She was stressed.  She has not been sleeping well lately.  And she had been feeling very irritable.  Little things were making her annoyed and she was over-reacting.  She had been feeling like nothing would work out for her and she was starting to think about suicide. 

Fortunately, this girl presented for treatment and we were able to provide her some brief psychotherapy and start and antidepressant medication which drastically improved her mood and behavior.

We often think of Depression as feeling sad or blue and crying more.  But depression does not always present this way.  Often, irritability can be a presenting feature of Major Depression. 

When working with families, I sometimes meet with a father who is short tempered and reactive.  Family members walk on egg-shells to avoid a conflict.  He may be a workaholic.  He sees himself as task oriented, but coworkers find him difficult and overbearing.  He looks tired from poor sleep.  He is depressed and does not know it.  Sometimes I meet a mom who is “flying off the handle” and “snapping” easily.  She reports mood swings and decreased enjoyment from her life. 

I often see children who have stopped enjoying activities they have usually liked, have given up friends, and tell me they get easily annoyed by little things.  Often as we explore more we discover an untreated depression.  A while back I met with a kindergartener who had always been sweet and loving.  The parents knew something was wrong when he erupted in class after a little girl came over to compliment his painting.  He took his paintbrush and destroyed his work and hers.   He had become angry and irritable and cried easily.  He told me he felt like a bad boy and wished he were dead.  He had gone out in the road and sat down, wishing a car would hit him, but he hadn't told anyone.

Depression is a biochemical, metabolic change in the brain that can present with sadness or irritability.  It often can cause loss energy, lack of enjoyment in activity, and decrease in concentration.  There may be sleep or appetite disturbance.   Stress or anxiety may be present.  Depression often runs in families.

If an individual suspects that they or a family member are depressed, they should meet with a mental health professional or their primary physician to explore the diagnosis further.   Antidepressant medication can often be effective and well tolerated.  Cognitive behavioral therapy can also be helpful.  Exercise, a healthy diet, and good sleep hygiene can also help improve mood.  Some studies have suggested that Omega 3 fatty acid supplements (fish oil) may help promote a good mood, too.

To learn more about features of depression and treatment options, visit my website  To schedule an appointment you may call my office at 214-550-3367.

Andrew M. Portteus, MD, MPH, PA

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