Whenever Alex, a 48-year-old in marketing, received a modicum of criticism from his manager, he’d brood for days on end. “I’d just walking around, seething,” he says. “But I was able to keep a game face on, at least at work.” Then, one day “out of nowhere,” he snapped.
“I had an outburst at home and broke my hand punching a wall,” he says. “I knew I had a quick temper — I’d go from 0 to 100 in a few seconds and stay that way for days at a time — [but] after having to go to the ER because of my anger outburst, I realized the anger was my responsibility.”
Alex was already on a low dose of Celexa for his anxiety; he practiced yoga and meditation to help curb his anger. But these treatments were “palliative at best — I would feel better while doing it but it had no lasting effect through the workday and didn’t provide any tools for dealing with heated exchanges,” he says.
So wearing a cast, he finally brought up his temper issues to his therapist, who in turn prescribed Xanax. But Alex realized “meds alone couldn’t fix [him],” so he took an online class and bought 10 books about anger management. He also kept an “anger journal” to log his angry feelings in order to learn his triggers.
Alex is a frequent contributor to the subreddit r/Anger, where men like himself seek help from a community of other people with short fuses — many of whom are prescribed, or are seeking a prescription for, medication to help manage their anger.
“I can’t control my anger,” writes one person in a post seeking advice on medication.
“I sometimes even just get randomly infuriated for no reason. … All the suggestions I’ve seen [are] new-age bullcrap like ‘mindfulness.’ Hopefully the doc I see will prescribe me one of those antidepressants that helps with anger. Or, heck, maybe even something to just knock me out when I’m in a fit. Either work for me. I hate being an angry mess all the time. How do I stop being angry?”
Psychotherapist Alex Ribbentrop tells MEL medication prescriptions to curb rage isn’t rare. “I have worked with a number of individuals that have been prescribed medication to support emotional regulation and in response to anger management,” he tells MEL. Generally, he says, a lot of these people are diagnosed with IED, or “intermittent explosive disorder,” which can be linked to “traumatic brain injury, while others may be a component of underlying mood and/or personality disorders.”
Whether it’s specifically IED or not, Ribbentrop says, medication can benefit someone who feels he can’t control his anger, “especially when taking into consideration the safety of the patient and others.”
However, Ribbentrop finds additional therapeutic interventions like meditation and anger journaling to be more effective. “Medication alone is rarely, if ever, an appropriate course of treatment,” he says, “so if medication is prescribed it should ideally be part of a comprehensive and integrative treatment plan taking into consideration biological, social and psychological factors, which will help to identify the most impactful and helpful interventions for treatment.”
Dr. Ceppie Merry, who has a Ph.D. in pharmacology from Trinity College in Dublin, agrees. “Medication should be reserved for men who have severe symptoms or have failed to respond to non-pharmacological interventions such as talk therapy, behavioral therapy, relaxation therapy, meditation, avoiding drugs and alcohol, and learning self-care.”
In other words, taking medication to control angry outbursts is a last resort, in part because many of the medications have awful side effects. Merry tells MEL the common prescriptions for anger are the class of antidepressants SSRIs (selective serotonin reuptake inhibitors), which can cause “drowsiness, nausea, dry mouth, insomnia, nervousness, agitation, restlessness, reduced sexual desire and/or erectile dysfunction.”
Take Alex, for example, who says the medication made him “cloudy over time. Like you’ve been walking in a fog.” He says as soon as he came off his medication, “the immediacy of all my old apprehensions came rushing back.” Without the medication to numb him from all his triggers, he had to “relearn how to cope with everything.” Alex is still on Celexa to curb his anxiety, but commits every day to controlling his anger without the help of Xanax.
Could the U.S. judicial system take advantage of the fact that guys like Alex can be so easily zombified via medication? Though it sounds a little dystopian, the short answer is yes and no. I spoke to a lawyer in Chicago, speaking anonymously, who says a judge can “require someone be committed to a psych ward or require they get an evaluation,” but not prescribe medication directly.
The lawyer says it might depend on the circumstances and type of law you’re dealing with, however. For example, she used to work in the Office of Public Guardians, where “judges required people to go to anger management classes or therapy or stay on their meds as conditions to get their kids back — they did that sort of thing all the time.”
Still, “they can’t actually require someone to start taking meds too unless a doctor or psychiatrist initiated it,” she says.
Beyond medication, Dr. Merry adds, some convicts may be diagnosed with IED “to try to explain criminal behaviour and ask for clemency.”
“A really interesting study from 2017 from Iowa University and the U.S. Probation Service found that 3.6 percent of federal correctional clients had a diagnosis of intermittent explosive disorder or what they called ‘criminally explosive,’” she says. “Offenders in the ‘criminally explosive’ category were arrested for murder, attempted murder, interference with police, aggravated assault, simple assault and domestic assault. … Many offenders with a diagnosis of intermittent explosive disorder will be repeat offenders.”
Despite the numbers, Merry still advises against throwing medications at anyone with an anger problem. “I often think that many people would choose non-pharmacological solutions if they knew about the list of possible side effects,” she tells MEL, adding that “one of the most important things is supporting people who live with men with explosive rage.
“This means giving very practical advice on having an escape plan and ensuring that firearms are kept safely locked away.”
And what about Alex? How is he doing outside the fog of Xanax, but busy tampering down any angry explosions?
After much internal reflection, he says the “real triggers were based in my internal assumptions about how things should be: that I should be right, that my anger was justified. It took a long time to tease that out because I didn’t want to believe it.
“But after I finally got over myself it came easier and easier,” Alex says. “Nowadays, about three years later, I almost laugh at myself when I realize how misguided I was, [and] after all that work I don’t really have big outbursts any more, and when I do I recover much quicker.
“But it’s work. Every day it’s important to remember that my goal is to give others the best chance I can give them and to not be negative toward myself.”