REVIEW OF: Rivas-Vazquez RA et al, Prim Care Companion CNS Disord 2025;27(1):24m03808

STUDY TYPE: Retrospective cohort study

Depression in older adults often shows up sideways: less sadness, more edge. Yet our go-to screeners don’t ask about irritability. This study looked at whether irritability might flag depression in adults 60 and older.

Researchers reviewed charts of 1,317 cognitively intact patients (mean age 73) referred to a neurology clinic for cognitive or behavioral concerns. Depression was defined as a Beck Depression Inventory-II (BDI-II) score of 13 or more. Irritability was assessed with two simple questions from the South Florida Cognitive Screener: one self-report (“Are you more irritable than usual?”) and one from a family member or friend (“Has a friend or family member told you that you are more irritable?”).

Forty percent of participants endorsed irritability by self-report or observer report. Thirty-seven percent met the BDI-II cutoff for depression. Among depressed patients, 54% reported irritability, compared with 20% of nondepressed patients. BDI-II scores rose stepwise with irritability. Older adults without irritability averaged 8.8. If irritability was noted only by an observer, the mean rose to 10.8. Self-reported irritability alone averaged 14.5. When both patient and observer endorsed irritability, scores were highest at 16.9.

This was a single specialty clinic with a largely Hispanic population, so generalizability is uncertain. We also don’t know whether adding irritability improves detection beyond the PHQ-9.

CARLAT TAKE

If you’re screening an older adult for depression, add a quick irritability question (and ask the family, too). More than half of depressed patients in this sample endorsed it, and severity climbed when others noticed it as well. Irritability isn’t diagnostic, but in late life it’s often the smoke that tells you to look harder for the fire.