While anger is a normal human emotion, it is one that can easily get out of hand and become overwhelming, potentially causing you and your relationships to suffer needlessly. There are a number of therapeutic options and/or classes for people who are having difficulty managing anger, but this process can take significant time and energy. If you are struggling with controlling anger, there are a number of medications--both prescription and over-the-counter--your physician may recommend to support you as you learn in therapy to manage feelings of anger in a constructive way.
Physiology of Anger
Anger so can readily overwhelm people because there are a number of physiological reactions that occur when anger surfaces that create the need for a physical release. Hormones flood the body, blood pressure and heart rate increase, and the body prepares itself to fight or to flee. There are many situations that do not allow people to respond in the way the body is programed to, so those physical responses have no way to be released. The anger state is thus prolonged, as it takes about 20 minutes for the physical changes to return to normal levels on their own.
Prescription Medications
There are no medications that target anger specifically, but there are a number of them that are prescribed for other conditions that may help anger symptoms, as well. The most commonly prescribed medications to help control anger are antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs). SSRIs work by blocking the absorption of serotonin, a chemical neurotransmitter, into the brain cells. This allows more serotonin to be present in the synapses, which are the open spaces between nerve cells. Greater levels of serotonin in the synapses has been shown to alleviate depression, anxiety, and other mood symptoms, including anger. There are a number of time-tested, effective SSRIs available today.
Citalopram
Citalopram (brand name Celexa) is safe and effective for most adults, but it is not generally recommended for use in children under 18 years old. Patients who are taking pimozide or being treated with methylene blue injection should not take this SSRI, nor should anyone who has taken an MOA inhibitor in the last 14 days. Additionally, people who have certain medical conditions should choose a different drug. This drug is not recommended for women who are pregnant or breastfeeding.
As with all antidepressant medications, some work better than others for different people, so some trial and error may be required before symptoms are alleviated, and SSRIs in general can take some weeks to become fully effective. There are a number of known side effects, but typically these are mild and diminish as your body gets used to the drug. The most common are:
- Nausea
- Drowsiness
- Diarrhea
- Difficulty sleeping
- Sexual dysfunction
- Dry mouth
- Quivering
The cost for Celexa and citalopram varies based on a number of factors, but for people paying out-of-pocket, taking advantage of the available generic and prescription discounts can significantly decrease the cost. Celexa in tablet form can cost between approximately $35.00 and $52.00 for a month's supply. The generic form, citalopram is quite a bit less expensive, less than $10.00 monthly.
Escitalopram
Like citalopram, escitalopram (brand name Cipralex or Lexapro) is safe and effective for many adults and can also be prescribed for children and adolescents. Although these two drugs are very similar, Lexapro differs in that it is often prescribed, and is effective for, the treatment of generalized anxiety disorder in addition to depression, so it may be the preferred choice for people who have both anxiety and anger issues. As with other SSRIs, Lexapro interacts with MOA inhibitors, pimozide, and methylene blue injections. Women who are pregnant or nursing will want to talk about potential risks with their physician before taking any SSRI. Lexapro also interacts with alcohol. Common side effects include:
- Nausea
- Dry mouth
- Constipation or diarrhea
- Dizziness
- Headache
Although Lexapro and Celexa are similar chemically, Lexapro costs significantly more, both in the brand name and the generic form. Both are very effective, but Lexapro is thought to be somewhat more selective in its action than Celexa; it is believed to affect other neurotransmitters operating in the brain to a lesser degree. Even with drug discounts, Lexapro can cost more than $300 for a 90 day supply. Escitalopram averages around $10.00 a month with discounts, though these costs can vary based on a number of factors.
Fluoxetine
Fluxotine (brand names Prozac, Sarafem, and Pexeva) is also an SSRI that has the same interactions as those mentioned above. Prozac is an older antidepressant medication, and it may cause more side effects in some patients, so practitioners often prefer to prescribe one of the newer antidepressants. However, Prozac is effective for a wider array of mental health conditions, including bi-polar disorder, panic disorder, and bulimia nervosa, so it may be a more appropriate choice for those who are managing these conditions. Like Lexepro, it is safe for children and adolescents. Common side-effects include:
- Vivid dreams
- Dry mouth
- Sore throat
- Loss of appetite
- Sweating
- Sexual dysfunction
Name brand Prozac is quite expensive; it can run from $200.00 to more than $400.00 monthly. The generic fluoxetine is much more economical, averaging about $15.00 for a 90-day supply for the capsule. Tablets and extended-release capsules may cost more.
Fluvoxamine
Fluvoxamine (brand name Luvox), like other SSRIs, can treat a variety of mental health conditions, but it is often primarily prescribed for those who have obsessive-compulsive disorder (OCD). It has also been effective for panic disorder, eating disorders, depression, and social phobias. There are a host of drugs that can negatively interact with Luvox, so it is important to talk with you health care provider about all the medications you take, both prescription and over-the-counter. Common side-effects include:
- Constipation
- Dizziness
- Sleepiness
- Loss of appetite
- Sexual dysfunction
Compared to some of the other SSRIs, Luvox is fairly expensive, even in the generic form. Fluvoxamine can cost from $5.00 to more than $100 for 30 tablets, and Luvox ranges from $100.00 to more than $200.00 per month, even with drug discounts.
Paroxetine
Paroxetine (brand names Paxil and Paxil CR) is prescribed to treat a broad array of mental health conditions, including panic disorders, obsessive-compulsive disorder, anxiety disorders, and social phobias. It can also be effective for treating hot flashes brought about by menopause. Paxil is not safe for women who are pregnant or nursing, nor is it recommended for children or adolescents. There are a number of known drug interactions, just as there are for other SSRIs, so be sure and check with your physician about your current medications. Common side-effects include:
- Dry mouth
- Constipation
- Sexual dysfunction
- Nausea
- Decreased appetite
Although the name brand drug can cost between $100.00 and $200.00 for a month's supply, the generic version is far less costly, averaging around $20.00 a month with drug discounts.
Sertraline
Sertraline (brand name Zoloft) also treats a wide array of mental health conditions and presents many of the same interactions and adverse effects when combined with other drugs. Unlike Paxil, it can be prescribed for pregnant or nursing women and is safe for children and adolescents, though you should talk over the risks with your physician. Side-effects are typically mild, but can include:
- Dizziness
- Sleepiness
- Dry mouth
- Nausea or vomiting
- Sexual dysfunction
- Difficulty sleeping
- Constipation or diarrhea
Costs are on par with other SSRIs, with the generic being significantly less costly. Paying out-of-pocket, Zoloft costs between $150.00 to $200.00 per month and the generic averages about $8.00 with discounts.
It is important to discuss the pros and cons of each these medications with your doctor prior to beginning treatment. Although SSRIs are in general quite effective for most people, it is possible to see little or no result with one and get great results with another for unknown reasons. In addition to these prescription medications, some types of non-prescription drugs may be just as beneficial and may come with fewer side-effects.
Over-The-Counter Medications
There are some readily available non-prescription medications that may relieve feelings of anger, but it is a good idea to talk over these options with your medical provider. Many over-the-counter drugs or supplements can interact with each other or with specific types of prescriptions, so it is best to be cautious and informed before starting a drug to help manage anger.
Valerian
Valerian root is an herbal supplement that is often used to promote quality sleep and reduce anxiety. Like SSRIs, herbal remedies do not target anger directly, but may be helpful in reducing anxiety and stress, making anger a less likely response to the stresses of daily life. Valerian can interact with other drugs and should not be taken with other sedatives or with alcohol. Valerian can leave you feeling hung over in the morning, and prolonged use may actually cause insomnia. There is little research to support the use of valerian as an anxiolytic, but many people do find that it helps them. Women who are pregnant or nursing should not use valerian since its effects are unknown.
Passion Flower
Passion flower is a plant native to the Southeastern region of the United States. It works much the same way as valerian, though it is milder in form. Both are thought to increase gamma aminobutyric acid (GABA) in the brain, which results in a more relaxed state. Though there are few risks associated with taking passion flower for short periods of time, it is important to talk with your physician about using them for your particular situation. It can react with other medications and should not be used by pregnant or nursing women or children. Though it is not a sedative itself, it should not be taken with them, as it may enhance the sedative effects.
Chamomile
Chamomile is an herbal supplement that is often used as a sleep aid and to enhance relaxation. It has been revered for its medicinal qualities for centuries and is generally thought to be safe. It may contain chemicals that bind with the same receptors as valium, thus producing a mildly sedative effect. There are few risks associated with consuming chamomile in small quantities, but it does have some slight blood thinning properties, so it should not be taken for a few weeks prior to any surgery. As with any supplement, it is important to talk with your health care professional about the benefits and risks for using it as an anger management aid.
Benadryl
Benadryl (diphenhydramine) is an antihistamine that has sedating effects and provides relief from anxiety for some people. Using Benadryl as an anger management aid should be discussed first with your physician as there is little research to support its effectiveness. Although Benadryl is considered safe for most people, it should not be taken without a doctor's consent by those who have glaucoma, enlarged prostate, hyperthyroidism, hypertension, or asthma.
The Long-Term Picture
Learning to manage your anger effectively is a process, but it is worthwhile, and even necessary, to live life successfully and healthily. There are numerous studies that show the negative effects that stress and anger have on the body, so learning to reduce anger can improve both mental and physical health, as well as your relationships. Electing to supplement counseling or anger management classes with medication may be a very wise choice, especially during those times that responsibilities and frustrations seem overwhelming. Most anger medications can be taken for a short while until more permanent coping strategies can be implemented, and generally, the side-effects and risks are fairly mild. Consulting with your physician and talking with your loved ones can put you on the path to a healthier and happier life.
