![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by tina on April 9, 2001, at 8:34:54
Does anyone know if irritation, intolerance and anger are associated with an increase in tricyclic dose? I've noticed my mood getting nastier and bitchier lately. It is hard to go to work. I work with the public and sometimes I just can't stand them and have wonderful fantasies about killing them in slow, agonizing ways. I'm also very short tempered and the anger doesn't fade away, it just gets bigger. Door slamming, kicking things, just generally annoyed all the time.
If I can't handle something, I used to withdraw or cry, ow I bite off heads and throw things. Almost like a tantrum but I'm outside of myself, watching like I have no control over this alter-ego. it's creepy.
If anyone has any experience or advice, I would really appreciate hearing it.
thanks
tina
Posted by SalArmy4me on April 9, 2001, at 8:45:45
In reply to amytriptiline, and anger, posted by tina on April 9, 2001, at 8:34:54
You may need an anticonvulsant to deal with the anger episodes. Divalproex and carbamazepine are recommended by the Tips for that problem: http://www.dr-bob.org/tips/split/Mood-stab-stim-for-anger.html
I myself take Depakote _ER_ for anger/irritation, and have had success. I used to snap at my own mother.
Posted by tina on April 9, 2001, at 9:38:03
In reply to Re: amytriptiline, and anger » tina, posted by SalArmy4me on April 9, 2001, at 8:45:45
I take klonopin too. Isn't that categorized as an anticonvulsant?
I have been on depakote and was manic on it. Tried lithium too and went very frantic and crazy. Never tried the carbamazepine though. What is it? Is it Tegretol(brand name)> You may need an anticonvulsant to deal with the anger episodes. Divalproex and carbamazepine are recommended by the Tips for that problem: http://www.dr-bob.org/tips/split/Mood-stab-stim-for-anger.html
>
> I myself take Depakote _ER_ for anger/irritation, and have had success. I used to snap at my own mother.
Posted by medlib on April 9, 2001, at 21:00:55
In reply to Re: amytriptiline, and anger-salarmy4me, posted by tina on April 9, 2001, at 9:38:03
Tina--
Yes, both Klonopin and Tegretol (carbamapine) are classed as anticonvulsants, but they belong to separate subclasses, so *how* each suppress seizures is different. (Anticonvulsants also vary on how effective they are for the several different types of seizures.) Klonopin is a benzodiazepine (like Valium, Xanax, etc.); as such, it is often prescribed for anxiety. Tegretol is an older "miscellaneous" class AC most often rxed for generalized seizures. Some find Tegretol more sedating than other ACs of its type (misc.), such as Depakote, so I think it's less often prescribed as a mood stabilizer.
I believe that the anger symptoms you describe may be evidence of the onset of an episode of hypomania--especially since you've had mood swings in response to other meds, and since your anger, etc. appeared after an increase in your TCA med. (I think of hypomania as an "up" without any ups--that is, activating, but absent the good mood or increased productivity of mania.) IMHO, it would be wise to check this out with your pdoc sooner, rather than later.
Are you as tired of playing "musical meds" as I am? Personally, my patience with endless "tweaking" is wearing very thin--and it's getting increasingly difficult toHang in---medlib
Posted by willow on April 9, 2001, at 22:08:27
In reply to Re: amytriptiline, and anger » tina, posted by medlib on April 9, 2001, at 21:00:55
"... and since your anger, etc. appeared after an increase in your TCA med."
I don't understand! Isn't the rage just a side-effect of the medication? When the med is withdrawn the ager returns to normal.
Willow
Posted by medlib on April 10, 2001, at 0:48:14
In reply to Re: amytriptiline, and anger » tina, posted by medlib on April 9, 2001, at 21:00:55
Tina--
Please ignore the second paragraph of my earlier message to you! My understanding of hypomania is INCORRECT. It was exceedingly irresponsible of me to post "information" which I had not checked, and I am very sorry and embarrassed to have done so. Although the mood shift you described probably should be brought to the attention of your pdoc, it does not fit the definitions of hypomania.
The drug info in my first paragraph *was* checked, although how often Tegretol is rxed as a mood stabilizer vs. Depakote is just my impression, not something I can verify.
Again, I apologize for my error. I'll refrain from posting after my methylphenidate (Ritalin) has worn off from now on--it leaves me fuzzier than I had realized.
A chastened medlib
Posted by tina on April 10, 2001, at 17:51:04
In reply to Mea CulpaTo Tina--Correction to previous post, posted by medlib on April 10, 2001, at 0:48:14
> Tina--
>
> Please ignore the second paragraph of my earlier message to you! My understanding of hypomania is INCORRECT. It was exceedingly irresponsible of me to post "information" which I had not checked, and I am very sorry and embarrassed to have done so. Although the mood shift you described probably should be brought to the attention of your pdoc, it does not fit the definitions of hypomania.
>
> The drug info in my first paragraph *was* checked, although how often Tegretol is rxed as a mood stabilizer vs. Depakote is just my impression, not something I can verify.
>
> Again, I apologize for my error. I'll refrain from posting after my methylphenidate (Ritalin) has worn off from now on--it leaves me fuzzier than I had realized.
>
> A chastened medlibI always take everything with a grain of salt. After all, "my mileage may vary" and I DO appreciate the information.
thanks to everyone who responded. I'm seeing my pdoc on thursday and will discuss this recent irritation episode with her then.
thanks again and I hope you are all doing well
tina
Posted by SLS on April 11, 2001, at 11:53:27
In reply to amytriptiline, and anger, posted by tina on April 9, 2001, at 8:34:54
Hi Tina,
If you increased both the tricyclic and the Klonopin at roughly the same time, alternate explanations might include:1. If you are being treated for depression, these feelings and behaviors might be the early signs of an improvement of depression. This sort of anger and irritability often occurs during the early weeks when one is responding to an antidepressant.
2. The Klonopin is causing an infrequent reaction called "disinhibition". This represents a change in the balance of brain activity that is meant to control certain emotions, including anger and rage. It works in a way similar to alcohol.
If this state passes and you begin to recognize a true improvement in depression, #1 is the more likely of the two explanations.
I am sure that there are many other alternative explanations that I haven't considered here.
Hopefully, your "bitchiness" is the prelude to happiness. :-)
- Scott
> Does anyone know if irritation, intolerance and anger are associated with an increase in tricyclic dose? I've noticed my mood getting nastier and bitchier lately. It is hard to go to work. I work with the public and sometimes I just can't stand them and have wonderful fantasies about killing them in slow, agonizing ways. I'm also very short tempered and the anger doesn't fade away, it just gets bigger. Door slamming, kicking things, just generally annoyed all the time.
> If I can't handle something, I used to withdraw or cry, ow I bite off heads and throw things. Almost like a tantrum but I'm outside of myself, watching like I have no control over this alter-ego. it's creepy.
> If anyone has any experience or advice, I would really appreciate hearing it.
> thanks
> tina
Posted by KarenB on April 12, 2001, at 22:05:23
In reply to amytriptiline, and anger, posted by tina on April 9, 2001, at 8:34:54
Tina,
Increased agitation from an activating AD is a good indicator of Bipolar illness. At least it's a good possibility. You may benefit from a mood stabilizer - I know I have and I was misdiagnosed with unipolar depression for almost two decades. I just thought the irritability was a character flaw or part of the depression, or both. I beat myself up internally for this on a daily basis, thinking I was just an inherantly bad person. Since my moods have been (for the most part) stabilized, my mind doesn't go there anymore.
As I have gotten older, I have less "highs" and more irritable, annoying manic episodes. I am mad at everything and hyper-critical of everything and everyone around me when this happens. Fortunately for those around me, I have, over time, learned to (mostly) keep my mouth shut...and pray a lot.
Let us know how your appt. with pdoc went today. I'm interested to hear what he/she had to say.
Karen
Posted by tina on April 16, 2001, at 21:11:43
In reply to Re: amytriptiline, and anger » tina, posted by KarenB on April 12, 2001, at 22:05:23
Pdoc appointment was a bust. She gave me Buspar. Apparently the worlds' most expensive placebo according to most people including the pharmacist that filled the prescription.
I'll let you know how that goes. Right now, all i can say is it's giving me unbelievable headaches.
Tina
> Tina,
>
> Increased agitation from an activating AD is a good indicator of Bipolar illness. At least it's a good possibility. You may benefit from a mood stabilizer - I know I have and I was misdiagnosed with unipolar depression for almost two decades. I just thought the irritability was a character flaw or part of the depression, or both. I beat myself up internally for this on a daily basis, thinking I was just an inherantly bad person. Since my moods have been (for the most part) stabilized, my mind doesn't go there anymore.
>
> As I have gotten older, I have less "highs" and more irritable, annoying manic episodes. I am mad at everything and hyper-critical of everything and everyone around me when this happens. Fortunately for those around me, I have, over time, learned to (mostly) keep my mouth shut...and pray a lot.
>
> Let us know how your appt. with pdoc went today. I'm interested to hear what he/she had to say.
>
> Karen
Posted by KarenB on April 18, 2001, at 12:34:49
In reply to Re: amytriptiline, and anger-Karen, posted by tina on April 16, 2001, at 21:11:43
I'll let you know how that goes. Right now, all i can say is it's giving me unbelievable headaches.
> Tina
> >Tina,
If you still want to give it a chance, you may ask to doc for something like Inderal (a beta Blocker) to take care of the headaches. If not, call back and COMPLAIN. She/he will probably take another route.
Good luck!
Karen
Posted by SLS on April 22, 2001, at 0:19:47
In reply to amytriptiline, and anger, posted by tina on April 9, 2001, at 8:34:54
Hi Tina.
> Does anyone know if irritation, intolerance and anger are associated with an increase in tricyclic dose? I've noticed my mood getting nastier and bitchier lately. It is hard to go to work. I work with the public and sometimes I just can't stand them and have wonderful fantasies about killing them in slow, agonizing ways. I'm also very short tempered and the anger doesn't fade away, it just gets bigger. Door slamming, kicking things, just generally annoyed all the time.
> If I can't handle something, I used to withdraw or cry, ow I bite off heads and throw things. Almost like a tantrum but I'm outside of myself, watching like I have no control over this alter-ego. it's creepy.
I found a citation that Cam W. offered in a post about a year ago. The study seems to have focused on patients with borderline personality disorder (BPD). That you used the word "tantrum" causes me to wonder if you have been diagnosed with BPD.
------------------------------------------------
Am J Psychiatry 1986 Dec;143(12):1603-5 Related Articles, Books, LinkOut
Paradoxical effects of amitriptyline on borderline patients.Soloff PH, George A, Nathan RS, Schulz PM, Perel JM.
A paradoxical increase in suicide threats, paranoid ideation, and demanding and assaultive behavior occurred among 15 borderline inpatients receiving amitriptyline in a double-blind study. This pattern differed significantly from that of 14 nonresponding patients receiving placebo.
Publication Types:
Clinical trial
Controlled clinical trialPMID: 3538914 [PubMed - indexed for MEDLINE]
Posted by Tony P on April 22, 2001, at 0:59:46
In reply to Re: amytriptiline, and anger » tina, posted by SLS on April 22, 2001, at 0:19:47
I think Buspar gets an unnecessary bad press, for some reason. It has worked very well for me for several years. I take it with Serzone, which helps to keep my endogenous all-the-time depression under control. The Buspar seems to help with the anger and depression that come from stress. I took 10mg twice a day initially, currently usually 10mg once a day, 5mg when things are going really well.
The first thing I noted with Buspar was that I stopped yelling at my kids as soon as I came home from work, so for at least one person it helps with that out-of-nowhere anger. The strange thing is, it also makes me more energetic and assertive. Obviously, it doesn't work for everyone, but I've talked to a couple of people who have discovered the same combination (Serzone+Buspar) works for them.
Re the increase in anger, I think many A/Ds have the potential to bring out anger, for several different reasons, a couple of which have been mentioned. And while some of it may be buried anger surfacing, I am convinced that some of it is purely artificial, chemically induced. I'm no expert, but I suspect some of them cause an imbalance in some hormones (norepinephrine would be one) which are directly associated with anger and fight-orflight response.
On a more personal level, my wife took Prozac for some time, and became ridden with rage. After switching to Zoloft and gaining some perspective, she described Prozac as the "mad drug" and Zoloft as the "sad drug". BTW, after a while on Paxil, she has now been medication-free for a couple of years.
Tony P.
> Hi Tina.
>
> > Does anyone know if irritation, intolerance and anger are associated with an increase in tricyclic dose? I've noticed my mood getting nastier and bitchier lately. It is hard to go to work. I work with the public and sometimes I just can't stand them and have wonderful fantasies about killing them in slow, agonizing ways. I'm also very short tempered and the anger doesn't fade away, it just gets bigger. Door slamming, kicking things, just generally annoyed all the time.
> > If I can't handle something, I used to withdraw or cry, ow I bite off heads and throw things. Almost like a tantrum but I'm outside of myself, watching like I have no control over this alter-ego. it's creepy.
>
>
> I found a citation that Cam W. offered in a post about a year ago. The study seems to have focused on patients with borderline personality disorder (BPD). That you used the word "tantrum" causes me to wonder if you have been diagnosed with BPD.
>
>
> ------------------------------------------------
>
>
> Am J Psychiatry 1986 Dec;143(12):1603-5 Related Articles, Books, LinkOut
>
>
> Paradoxical effects of amitriptyline on borderline patients.
>
> Soloff PH, George A, Nathan RS, Schulz PM, Perel JM.
>
> A paradoxical increase in suicide threats, paranoid ideation, and demanding and assaultive behavior occurred among 15 borderline inpatients receiving amitriptyline in a double-blind study. This pattern differed significantly from that of 14 nonresponding patients receiving placebo.
>
> Publication Types:
> Clinical trial
> Controlled clinical trial
>
> PMID: 3538914 [PubMed - indexed for MEDLINE]
Posted by SLS on April 22, 2001, at 9:48:15
In reply to Re: amytriptiline, and anger, posted by Tony P on April 22, 2001, at 0:59:46
Dear Tony,
I just wanted to stop-in and thank you for posting your experiences and thoughts. I am going to pay more attention to combinations using Serzone and Buspar. I agree with you that drug-induced changes in neurochemistry can yield anger and irritability.
Sincerely,
Scott
> I think Buspar gets an unnecessary bad press, for some reason. It has worked very well for me for several years. I take it with Serzone, which helps to keep my endogenous all-the-time depression under control. The Buspar seems to help with the anger and depression that come from stress. I took 10mg twice a day initially, currently usually 10mg once a day, 5mg when things are going really well.
>
> The first thing I noted with Buspar was that I stopped yelling at my kids as soon as I came home from work, so for at least one person it helps with that out-of-nowhere anger. The strange thing is, it also makes me more energetic and assertive. Obviously, it doesn't work for everyone, but I've talked to a couple of people who have discovered the same combination (Serzone+Buspar) works for them.
>
> Re the increase in anger, I think many A/Ds have the potential to bring out anger, for several different reasons, a couple of which have been mentioned. And while some of it may be buried anger surfacing, I am convinced that some of it is purely artificial, chemically induced. I'm no expert, but I suspect some of them cause an imbalance in some hormones (norepinephrine would be one) which are directly associated with anger and fight-orflight response.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.