Psycho-Babble Medication Thread 1050600

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Drugs for Rages, in context of mood disorder

Posted by BygoneBeSpade on September 13, 2013, at 11:49:36

Hello. I grew up in a pretty violent and abusive household. Without drugs I suffer from chronic intense anger - being angry ALL the time, so angry that I used to refuse to eat food for days in the early stages of the disorder if things did not go my way. Something would just not seem right, there was always this darkness and weird sort of the way the world seemed since my early teens. I also started having intense rage attacks all the time, my mind gets intensely mentally agitated, physically restless, extremely irritable and in a frenzy, and stress fills my head and I have to let the anger out in the form of breaking things, smashing glass objects, throwing/destroying furniture, crockery, and the like. These rage attacks are often caused by too much stress, fights, things do not go my way, etc. and all sorts of triggers, but I have no idea why I have this inappropriate rage. I always had depressive tendencies like loneliness etc. Since I was 15 I've had full blown severe depression, with all sorts of negative feelings like loneliness and no one loving me, and intense weeping all the time, not going out of my room at all, not even talking to my family. I was given AAPs since 5 years ago at age 17, Risperidone 3mgs worked very well for the rages from the start and it has a wonderful antidepressant effect too, other AAPs did not work well or were stopped because of side effects. Divalproex 750 mg with Lamictal 25mg made me horribly depressed with horrible horrible weeping all the time and I stopped it. Valproic acid made me severely depressed and felt sick on it. Aripiprazole 15 mg with Iloperidone 6mg made me extremely irritable, depressed and raging. Olanzapine 15mg locked up my behind so bad I couldn't let anything out for up to three days, even with laxatives. It didn't work well for rage and I had rage episodes on it. Fluoxetine 20mg did nothing for my depression. I have not taken other antidepressants except Mirtazapine which gave me horrible excess of problems that it's not fitting for a holy Christian man to even mention. So it's been Risperidone 3mg up till now, and I'm stable except for severe tardive dystonia and other side effects. Up till now, I'm only sure that I have MDD and though I've entertained that I might be bipolar, I've just had no happy moments ever, I'm just wallowing in severe depression and rage, no happiness but extremely severe depression all the time; even when raging, I have this diabolical underlying sadness and depression. So I'm not quite sure if I'm monopolar depressed or otherwise (though my instincts tell me monopolar). Doctors aren't quite sure either. Because of the side effects I'm looking for non-AAP options (maybe antidepressants or other drugs) that might help control this intense rage, extreme irritability, and psychic agitation while treating the severe depression. I've also had issues with self-harm - being so angry at myself and punching and beating myself because of guilt over the rages and other problems. But I really want help with how to proceed in trying new drugs, which might be worth a shot. The drugs I mentioned I tried, I took them as I wrote them, monotherapy the ones I mentioned singly and as combinations like I wrote them. I've tried them all for two months at least, except the Aripiprazole and Iloperidone which I took only for two weeks and stopped because of the rage. None of the other drugs worked for the rage either.

I've researched online and some places mention that intense anger, rages may respond to serotonergic drugs while others say that antidepressants can make agitation worse. Some place, namely Wikipedia says Amitryptyline is used in violent behaviour but doesn't mention in what context it is used and whether the anticholinergic side effects are even worth it. Some places say treating the underlying depression is the way to proceed while others say the aggression should be treated as a separate disorder. So I'm here to ask your advice, if there are any non-antipsychotic drugs that might be worth a shot at trying, keepin in mind side-effects.. and if so, which to try first, how to proceed. Thanks. Please, I beg you to help me get off this nasty risperidone.

 

Re: Drugs for Rages, in context of mood disorder BygoneBeSpade

Posted by Partlycloudy on September 13, 2013, at 13:05:55

In reply to Drugs for Rages, in context of mood disorder, posted by BygoneBeSpade on September 13, 2013, at 11:49:36

Hello, and first off, welcome to Babble. I am by no means one of the meds experts around here, but I wanted you to know that your post has raised my concern.
Not knowing your family background, I would start out saying that a medical approach might be helped by talk therapy, if only to get to the root of your depressive feelings. Anger itself gets its own attention therapeutically with many specialists addressing that issue alone.

I am going to let one of the med gurus here address your questions regarding mono therapy or what might work better for you. I would encourage you to give yourself a greater chance by introducing therapy of some kind.

I hope these forums are of some help to you. Sometimes, just finding someone else with a similar problem is a great comfort. So, as I said, welcome to Babble.

Partlycloudy

 

Re: Drugs for Rages, in context of mood disorder

Posted by alexandra_k on September 13, 2013, at 16:45:32

In reply to Re: Drugs for Rages, in context of mood disorder BygoneBeSpade, posted by Partlycloudy on September 13, 2013, at 13:05:55

What kind of exercise do you do?

 

Re: Drugs for Rages, in context of mood disorder BygoneBeSpade

Posted by Zyprexa on September 13, 2013, at 20:52:16

In reply to Drugs for Rages, in context of mood disorder, posted by BygoneBeSpade on September 13, 2013, at 11:49:36

Pot! Thats what got me through when I was being greatly reduced on my zyprexa and perphenazine.

I still get occasional anger since going back up on meds. Talk helps, but not with out the other drugs.

 

Re: Drugs for Rages, in context of mood disorder BygoneBeSpade

Posted by doxogenic boy on September 16, 2013, at 10:53:21

In reply to Drugs for Rages, in context of mood disorder, posted by BygoneBeSpade on September 13, 2013, at 11:49:36


Hello BygoneBeSpade,

Have you tried lithium? It can help against aggression. Here is some information:

http://www.ncbi.nlm.nih.gov/pubmed/1090706
Quote from the link above:
"Analysis of results in terms of the number of aggressive antisocial acts showed fewer serious aggressive episodes when the lithium level was between 0.6 and 1 meq/liter than when it was between 0.0 and 0.6 meq/liter. These results must be viewed with caution and are only suggestive since the study was not double blind."
End quote.


http://www.ncbi.nlm.nih.gov/pubmed/1639003

http://www.nhs.uk/medicine-guides/pages/MedicineOverview.aspx?condition=Restlessness,%20Agitation%20and%20Aggression&medicine=lithium%20carbonate

- doxogenic

 

Re: Drugs for Rages, in context of mood disorder doxogenic boy

Posted by BygoneBeSpade on September 16, 2013, at 13:17:19

In reply to Re: Drugs for Rages, in context of mood disorder BygoneBeSpade, posted by doxogenic boy on September 16, 2013, at 10:53:21

Thanks for the reply about lithium. I was feeling a little morose after reading the others' suggestions of Pot, therapy, and exercise to quell my rages. I think I would fail at all three, having tried therapy for a while before but just felt disinterested in it. Severe fatigue from depression and sedation from risperidone isn't helping me exercise. And I have no idea where I can get some cannabis in the north-east part of India; I certainly know of no one who keeps pot. They have valid points though.

About lithium: I have not tried it, but I'm a little wary of it since I heard it can be hard on kidneys and cause eps/hand tremors. But it might be worth a try, I guess. I will wait for more opinions about drugs. One of the major problems is that I really need something that works fast, hopefully in days, not weeks and months, because this rage problem makes it difficult for me to be in any kind of peace, so getting off risperidone for any period of time and waiting for drugs to be titrated to therapeutic levels will probably be a big burden. So I'm thinking this through. How speedily does lithium work on that front?

 

Re: Drugs for Rages, in context of mood disorder

Posted by BygoneBeSpade on September 16, 2013, at 13:38:47

In reply to Drugs for Rages, in context of mood disorder, posted by BygoneBeSpade on September 13, 2013, at 11:49:36

I wanted to ask a question: I was reading the "soft signs" of bipolar and it was written in places that multiplicity of moods- like episodes of irritability followed by episodes of rage followed by depression is an indicator of bipolarity. However, I'm a bit confused about how unipolar and bipolar are distinguished (I've never thought about my episodes as "moods" but always as a combination of rage and depression) as I've heard it said that severe aggression can be associated with depression. So I wanted to know if the rages I described can be part of unipolar depression, as the unipolar vs bipolar issue is confusing me a lot? Dr Maurizio Fava of Harvard Medical School describes "anger attacks" in unipolar depression which can include irritability and physical aggression like throwing/destroying objects. However I wanted opinion whether the rages I describe could be such 'anger attacks' because in his studies, it is said that antidepressants like Sertraline can amolierate this 'anger attacks'. If however it is bipolar, I guess antidepressants are not ideal.

I also wanted to add that I also experience sleep issues when not on meds, desire to stay awake at night and sleeping in morning when exhausted (so sleep reversal). I'm not sure if I have experienced racing thoughts, in fact during rages I feel the opposite as if my thoughts are numbed and I can't think at all, and have to even force myself when speaking in the agitated anger. Sometimes during depression though I have my mind filled with a million thoughts with songs playing in my mind while I'm thinking thoughts/daydreaming about things I want to do in life and those thoughts excite my mind.

Sorry if this sounds like I'm asking too many questions, but I'm really confused about the issue of unipolar anger attacks vs bipolar dysphoria and whether I should trial antidepressants and would PLEASE like some clarification, if anyone would be so kind.

 

Re: Drugs for Rages, in context of mood disorder

Posted by doxogenic boy on September 16, 2013, at 14:07:28

In reply to Re: Drugs for Rages, in context of mood disorder doxogenic boy, posted by BygoneBeSpade on September 16, 2013, at 13:17:19

> About lithium: I have not tried it, but I'm a little wary of it since I heard it can be hard on kidneys and cause eps/hand tremors.

That is correct, but you can avoid the kidney problems if you monitor blood levels regularly. I think high doses of lithium work better against aggression than low doses, but you will most likely get some side effects.

>How speedily does lithium work on that front?

When lithium is used against bipolar disorder, it could take four weeks or more to stabilize mood, but I guess (but I don't know for sure) it works faster against aggression. If you have sleep problems, and you suspect that it worsens your aggression, Seroquel (quetiapine) may work for you.

Antidepressants can destabilize mood and can cause mania (and mania often is associated with aggression) so I think it should not be the first choice. They can work against aggression, but ADs are probably more unpredictable than lithium and antipsychotics for this indication.


 

Re: Drugs for Rages, in context of mood disorder BygoneBeSpade

Posted by Partlycloudy on September 16, 2013, at 15:50:12

In reply to Re: Drugs for Rages, in context of mood disorder doxogenic boy, posted by BygoneBeSpade on September 16, 2013, at 13:17:19

I just wanted to point out that I wouldn't consider talk therapy to be monotherapy for your depressive rages, but in conjunction with medication, it could speed the process of recovery. Also, one poor experience with a therapist is as much a reflection of the practioner as the patient. It takes time to find the right specialist for the job.

I hope you find some release soon.
PC

 

Re: Drugs for Rages, in context of mood disorder Partlycloudy

Posted by BygoneBeSpade on September 20, 2013, at 10:48:13

In reply to Re: Drugs for Rages, in context of mood disorder BygoneBeSpade, posted by Partlycloudy on September 16, 2013, at 15:50:12

Thanks for the input, Partlycloudy. Family members have been telling me to get therapy also alongside meds so will consider it.

 

Re: Drugs for Rages, in context of mood disorder

Posted by BygoneBeSpade on September 20, 2013, at 10:54:51

In reply to Drugs for Rages, in context of mood disorder, posted by BygoneBeSpade on September 13, 2013, at 11:49:36

Any thoughts on the usage of Propranolol (supposed to have level 1 evidence for aggression in tbi; i don't have tbi but any chance of it working for me?) and eslicarbazepine (derivative of oxcarbazepine)/oxcarb for this indication?? I'm curious especially about propranolol because it is supposed to have no/less troublesome side effects. Would also appreciate thoughts about anecdotal efficacy, speed of working, etc.

 

Re: Drugs for Rages, in context of mood disorder BygoneBeSpade

Posted by b2chica on September 20, 2013, at 15:41:11

In reply to Re: Drugs for Rages, in context of mood disorder, posted by BygoneBeSpade on September 20, 2013, at 10:54:51

i was on it for a while. really didnt do much for me.
it maybe took the edge off to sort of help me sleep (took it at night). however, really didnt seem to do much for anxiety or agitation.
on the plus side i had no side effects from it at all that i can remember. i think i only stayed on it for a month or two.

id say this is one drug couldnt hurt to try.
i think i was also on prozasin at one time. however that made me cry and severe depressive episode, so be wary of that one.

best wishes
b2

 

Re: Drugs for Rages, in context of mood disorder BygoneBeSpade

Posted by doxogenic boy on September 20, 2013, at 15:53:48

In reply to Re: Drugs for Rages, in context of mood disorder, posted by BygoneBeSpade on September 20, 2013, at 10:54:51

Have you thought more about lithium?

 

Re: Drugs for Rages, in context of mood disorder b2chica

Posted by BygoneBeSpade on September 21, 2013, at 1:55:02

In reply to Re: Drugs for Rages, in context of mood disorder BygoneBeSpade, posted by b2chica on September 20, 2013, at 15:41:11

Hi, may I know what dose of propranolol you were taking? Thanks.

 

Re: Drugs for Rages, in context of mood disorder doxogenic boy

Posted by BygoneBeSpade on September 21, 2013, at 1:57:15

In reply to Re: Drugs for Rages, in context of mood disorder BygoneBeSpade, posted by doxogenic boy on September 20, 2013, at 15:53:48

doxogenic boy, I'm getting an appointment with my doctor next week, and I'll discuss with him about lithium. Thanks.

 

Re: Drugs for Rages, in context of mood disorder BygoneBeSpade

Posted by doxogenic boy on September 22, 2013, at 16:00:42

In reply to Re: Drugs for Rages, in context of mood disorder doxogenic boy, posted by BygoneBeSpade on September 21, 2013, at 1:57:15

> doxogenic boy, I'm getting an appointment with my doctor next week, and I'll discuss with him about lithium. Thanks.

I hope you and your doctor find something that works, lithium or other meds, and I am interested to hear what you decide to do.

- doxogenic

 

Re: Drugs for Rages, in context of mood disorder BygoneBeSpade

Posted by phidippus on September 23, 2013, at 12:25:58

In reply to Drugs for Rages, in context of mood disorder, posted by BygoneBeSpade on September 13, 2013, at 11:49:36

Lithium FTW. Lithium has long been used to help control anger.

Eric

 

Re: Drugs for Rages, in context of mood disorder

Posted by SLS on September 23, 2013, at 19:43:35

In reply to Re: Drugs for Rages, in context of mood disorder BygoneBeSpade, posted by phidippus on September 23, 2013, at 12:25:58

> Lithium FTW. Lithium has long been used to help control anger.
>
> Eric

I have seen Tileptal used - sometimes in combination with Zoloft.


- Scott

 

Re: Drugs for Rages, in context of mood disorder SLS

Posted by phidippus on September 24, 2013, at 12:35:15

In reply to Re: Drugs for Rages, in context of mood disorder, posted by SLS on September 23, 2013, at 19:43:35

Any SSRI can inhibit aggressive behavior.

I have not seen Trileptal used to control aggression, but definitely Caarbamazapine.

Eric

 

Re: Drugs for Rages, in context of mood disorder

Posted by BygoneBeSpade on September 30, 2013, at 5:46:47

In reply to Drugs for Rages, in context of mood disorder, posted by BygoneBeSpade on September 13, 2013, at 11:49:36

Hello. I touched on the aggression topic with my pdoc and he's of the opinion that due to my fine response to risperidone and the type of anger that I have, acute mental agitation and physical agitation with destroying stuff out of frustration is certainly due to excess dopamine and even though I do not have psychotic symptoms, I should be taking dopamine antagonists for the anger. I'm not sure. My question is can it be said for certain that such aggression is dopamine related? Also, iloperidone and aripiprazole made me very raging also? Is that a normal response to these drugs if he's correct? It is true though that I do not understand this rage and the constant irritation in my head. I certainly have no reason to be angry. Maybe the violent childhood situation in my house affected my brain? He says he's certain that though I have a mood disorder of depression, the anger comes from excess dopamine and not any sort of mania. (It's funny how the doc can tell so much after just a few visits). Thanks.

 

Re: Drugs for Rages, in context of mood disorder BygoneBeSpade

Posted by doxogenic boy on September 30, 2013, at 7:20:46

In reply to Re: Drugs for Rages, in context of mood disorder, posted by BygoneBeSpade on September 30, 2013, at 5:46:47

> My question is can it be said for certain that such aggression is dopamine related?

No; I don't think it is possible to say for sure that it is dopamine related. Then he should have taken a dopamine blood test or a brain scan that showed such a correlation. As far as I know, there exist no such tests that are reliable.


>Also, iloperidone and aripiprazole made me very raging also? Is that a normal response to these drugs if he's correct?

I don't know if it is normal, but it is my guess that old neuroleptics such as haloperidol, perphenazine, chlorpromazine, levomepromazine, zuclopenthixol and chlorprothixene may work better against aggression than atypical antipsychotics. The old neuroleptics have horrible side effects though, especially akathisia, which can lead to suicide.

You can find out about mode of action for psychiatric drugs here:
http://www.psychotropics.dk/Search%20Psychotropics/defualt.aspx

Did you ask your doctor about lithium, and if so, what did he say? I think lithium is the best drug against aggression. And lithium has the best evidence for neuroprotective effects, and it increases BDNF.

http://www.researchgate.net/publication/7313048_Effects_of_mood_stabilizers_on_hippocampus_BDNF_levels_in_an_animal_model_of_mania/file/79e41508589a996f4a.pdf

>It is true though that I do not understand this rage and the constant irritation in my head. I certainly have no reason to be angry. Maybe the violent childhood situation in my house affected my brain?

That is possible. The brain is affected by all stimuli.

>He says he's certain that though I have a mood
disorder of depression, the anger comes from
excess dopamine and not any sort of mania. (It's
funny how the doc can tell so much after just a
few visits).

I don't think it is possible to tell that without blood tests or a brain scan.

- doxogenic

 

Re: Drugs for Rages, in context of mood disorder BygoneBeSpade

Posted by phidippus on September 30, 2013, at 15:57:24

In reply to Re: Drugs for Rages, in context of mood disorder, posted by BygoneBeSpade on September 30, 2013, at 5:46:47

Excess dopamine? Lack of serotonin can also cause aggression. If it were simply dopamine being the cause of your aggression, drugs like Illoperidone and Aripiprazole would have helped in your situation.

Why not try Lithium?

Eric

 

Re: Drugs for Rages, in context of mood disorder

Posted by BygoneBeSpade on October 1, 2013, at 7:37:11

In reply to Re: Drugs for Rages, in context of mood disorder BygoneBeSpade, posted by phidippus on September 30, 2013, at 15:57:24

Hello. I did ask about Lithium and he was not willing to talk much about it except saying he didn't think it would be beneficial.

I might be getting a second opinion when I have time. I'm also searching for a good psychotherapist to discuss all this with and get therapy. I guess they can also help with this as psychiatrists themselves (where I live) are not very communicative with patients. I'll update here if anything happens. Thanks.

 

Re: Drugs for Rages, in context of mood disorder BygoneBeSpade

Posted by phidippus on October 1, 2013, at 7:45:05

In reply to Re: Drugs for Rages, in context of mood disorder, posted by BygoneBeSpade on October 1, 2013, at 7:37:11

Your shrink sounds useless. Lithium and Prozac are the most widely prescribed drugs for anger management.

Eric

 

Re: Drugs for Rages, in context of mood disorder BygoneBeSpade

Posted by doxogenic boy on October 1, 2013, at 11:51:56

In reply to Re: Drugs for Rages, in context of mood disorder, posted by BygoneBeSpade on October 1, 2013, at 7:37:11

> Hello. I did ask about Lithium and he was not willing to talk much about it except saying he didn't think it would be beneficial.

Have you thought of getting another psychiatrist? Lithium is probably better (neuroprotective) for your brain than antipsychotics.

See this post about antipsychotics:
http://www.dr-bob.org/babble/20130828/msgs/1051297.html

- doxogenic


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