Could His Antidepressant Be Causing His Angry Outbursts?

Reader’s Question

After an outburst which involved physical abuse, my husband went to a mental health care provider who diagnosed him with anxiety disorder and prescribed an antidepressant. As soon as the antidepressant took effect, my husband’s behavior became increasingly erratic and abusive. He said that around everyone else he felt “amazing” and that I was the only thing that continued to make him anxious. His behavior became so out of control that I was counseled to separate from him for my safety. Could his medication be causing this angry behavior?

Our Consulting Clinical Psychologist’s Reply

Medication can create the behavior you describe, even when we consider his report that he has felt “amazing” in other social situations. Your information is not completely clear — he was diagnosed with an anxiety disorder, but then prescribed an antidepressant. However, some general considerations:

• If he has a history of aggressiveness, outbursts and physical assaultiveness, antianxiety medication can actually “disinhibit” him — that is, relax any control he has on these behaviors. It would actually make him more explosive and aggressive while in his view, he feels calmer.
• Antidepressants can produce an unusual side effect known as “SSRI-Induced Hypomania“. It’s a form of being “too happy”. A hypomanic episode often involves aggressiveness, feelings of elation (feeling “amazing”), physical hyperactivity, hypersexuality, talkativeness, racing thoughts, decreased need for sleep, and a few other symptoms. Physical restlessness and aggressiveness are often found when this happens. While friends and co-workers only receive a glimpse of his “amazing” mood and behavior, you would have been subjected to prolonged exposure and would have seen the irritability, aggressiveness, and short-fused temper. Imagine watching his behavior through a videocamera — Is he physically hyper? Wide-eyed and excited? Does he look “wired”? Talkative? And is this behavior not a normal characteristic of his personality? Importantly, if he is experiencing medication-induced hypomania, he may have little control over his impulsive aggression.
• If his behavior is medication-induced, he may not actually see it as a problem. Hypomania has a sense of elation and powerfulness that is seductive. He’s not likely to seek medical consultation for that reason. To obtain help, you may need to focus on the physical/medical symptoms of hypomania such as the hyperactivity, poor sleep, poor concentration, reduced appetite, etc. Suggest that he discuss these issues with his physician.
• One last caution. Psychiatrists are well-trained in recognizing and treating medication-induced hypomania. However, the vast majority of antidepressants are prescribed by family and OB/GYN physicians and physicians’ assistants/nurses. If a psychiatrist is prescribing, you may be able to send them a small note about your concerns. If a nonpsychiatrist MD or other professional is prescribing, they may miss the possibility of an SSRI-Induced Hypomania.

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