Dealing with anger during SSRI withdrawal — (npanth)

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by James Heaney

July 2, 2012

Anger is a normal human emotion.  It’s a force of change for most people.  We see something we don’t like in the world around us and feel compelled to change or avoid it. In our nuanced minds, we’ve developed sophisticated ways of expressing and dealing with anger.  We use discussion and logic to make anger serve us in productive ways.  SSRI withdrawal turns this normal process on its head. In withdrawal, anger forms independently in the mind.  Instead of rising in response to an external event, withdrawal causes anger without context.  You’re just angry.  There’s no event or emotion preceding it, it just pops into your head.

Normally, there is a range of emotion to anger.  We’ve separated physical and intellectual anger, and each has a range of responses. We moderate ourselves to match the event.  Instead of fighting an insulting person, we debate or avoid them.  Extreme responses are withheld until there is a threat of physical harm.  Withdrawal blurs the line between intellectual and physical anger and eliminates the scale that we usually apply to situations to gauge our responses.  Since withdrawal anger rises independently, there is no external scale to give us queues to measure our response.  The mind is filled with anger that we then try to apply to the situation.  That’s the key difference between normal anger and the rage that accompanies SSRI withdrawal.  Instead of reacting to an external event, we’re applying an internal state to the external world.

Because the internal mental state doesn’t match the external anger queue, people in withdrawal can often dramatically over react to small annoyances.  The anger that the patient is experiencing is at the upper scale of the emotion.  It’s happening without an external event to trigger it, so the mind searches for the cause of the anger, and attaches it to anything it sees in the outside world.  The patient may feel enough anger to start a physical altercation, and apply that rage to a trivial interaction.  Road rage is one of the most common responses to withdrawal anger.  Combining rage with the anonymity of the road removes the last few barriers in the mind between anger and action.

Anger is one of the most difficult emotions to deal with in SSRI withdrawal.  It’s the one emotion that the patient is most likely to translate into action against friends or strangers.  Anxiety, depression and fear are also amplified in withdrawal, but those emotions tend to draw the patient into themselves.  Anger is more likely to be expressed outwards towards other people.  For patients, it’s important to be mindful of the difference between normal anger and that caused by withdrawal.  If you’re angry and can’t see what triggered it, it’s most likely caused by withdrawal.  It’s a delicate point in withdrawal.  Be very careful not to do or say something that you will regret later.  This stage of withdrawal causes more broken friendships and burned bridges than any other.  It’s very hard to control anger in withdrawal, though.  Don’t berate yourself too much if you do something out of character, a lot of people experience the exact same thing.

For friends and loved ones, it’s important to suspend reactions to a person experiencing anger in SSRI withdrawal.  No matter how hurtful or mean they seem, the emotion is not normal anger.  It’s an out of control emotion that they are expressing incoherently.  They can still use their imagination and intellect to lash out, but the basis for the anger is beyond their control.  Attacks can seem very personal and elaborate.  They may bring up very old problems that seemed resolved long ago.  They’re not really trying to relive those old arguments, they are just clinging to anything that can explain the sudden and overwhelming anger they feel.  We’re not used to experiencing anger without context, so someone in withdrawal will grab onto anything to explain it.  As much as you can, be relentlessly positive.  S/he needs your support to get through this crisis.  Responding with anger will escalate the situation.  The patient has no real upper limit on their anger, but you do.  Try to moderate yourself and control your emotions.  It’s very hard to deal with a person suffering from withdrawal rage, but escalating the situation will not serve either of you in the long run.

The anger phase of withdrawal does pass.  The goal for the patient and those around him/her is to recognize that it wasn’t a normal part of their personality.  As strange as it seems, withdrawal can temporarily change your personality and make you do things that you would normally never do.  It’s not an emotional state that you’re likely to return to, either.  Once you pass through anger, there are other phases of withdrawal to deal with, but anger should slowly become more manageable as time goes by.  You may find that you are better equipped to deal with normal anger now that you’ve experienced irrational anger.  Instead of fearing that you may relapse into anger in the future, take heart that you have passed through the most difficult part of SSRI withdrawal.