When SSRIs help, in addition to improving general mood, they
break the cycle of rumination that is so essential to getting angry. Medi-
cations are most helpful to people who feel they’re controlled by their
anger. SSRIs don’t make anger go away, but they seem to slow down the
process enough that people can begin to recognize what’s going on and
interrupt it themselves.
The disasters are caused by the agitation that is a common side
effect of SSRIs and newer antidepressants. It can sometimes make angry peo-
ple muchangrier, to the point that it’s intolerable for them and the people
around them. For depressed people, the agitation effect seems to peak at
about the second or third day of treatment and then diminish. For angry
people, this may be too long to wait. If an angry person in your life starts
taking medication and begins to feel more agitated, call the prescriber
immediately. Angry people are often far more aware of what is going on
around them than they are of what’s happening in their own bodies, so
it’s a good idea to let them know that the agitation is coming from the
medicine, not a change in the universe.
Other medications, including anticonvulsants and betablockers, are
sometimes used in treating anger, especially with people who can’t tolerate
SSRIs. Benzodiazepines are not a good choice for irritability. They may
help initially, but they generally make the situation worse over the long
run. In fact, benzodiazepines are not a long run solution for anything.
For various reasons, most of these medications are contraindicated
with active substance abuse. At best, they won’t work. At worst, they can lead
to serious complications. Often, substance abusers neglect to inform their
doctors of that particular problem. If there is one in your life, encourage
him or her to come clean. Secrecy to substance abusers is as toxic as the
drugs they take.
224 ❧Explosions into Anger