Most patients with depression and other mood disorders never commit a violent act. However, clinicians should be aware that patients with mood disorders, particularly when they are experiencing active mood symptoms, are at an increased risk for violence compared to the general population. Depression may result in violent behavior, particularly in depressed individuals who strike out at others. Depression is the most common diagnosis in murder-suicides and mothers who kill their children are often suffering from severe depression. Two important factors relevant to depression and future violence risk includes violence in the 10 weeks prior to the assessment and co-occurring alcohol use. Although patients with mania show a high percentage of assaultive or threatening behavior, serious violence is rare unless associated with significant psychosis. Patients with mania most commonly exhibit violent behavior when they are restrained or have limits set on their behavior. As with depression, individuals with bipolar disorder demonstrate an increased risk of violence related to substance use comorbidity.
Scott CL and Resnick PJ: Clinical assessment of aggression and violence. In Principles and Practice of Forensic Psychiatry, Third Edition (Editors: Rosner R and Scott CL); CRC Press, Taylor & Francis Group, New York, 2017, pp 623-632.