My husband of 23 years describes himself as “melancholy”. He feels sad more than happy, mixed with a good dose of anxiety on most days. Currently, he owns his own business, which is successful (but he feels like it isn’t!), and he works from home. If you were to meet him, you would think he’s fun, interesting, hilarious, and just a blast to be around. Sometimes he’s like this at home, but mostly he’s just angry. He finds it difficult to “let go of things” once they’re in his mind. If someone or something upsets him (e.g. getting crumbs on the table or letting a mosquito in the house), he flips out and becomes extremely verbally abusive. Sometimes he has a hard time keeping his hands to himself when he’s upset, so he often jabs at me on my arm or even pushes or trips me. It has gotten to the point that he thinks nothing of calling me horrible names including fat, douche, a-hole, etc. in front of our pre-teen children. He is beginning to be verbally abusive toward the kids as well. Seven years ago, he tried to take an anti-depressant with a mood stabilizer, but they did not seem to be effective. He currently has a prescription for Xanax and Lunesta, which he takes every third day or so. He drinks alcohol to relax every night, which seems to exacerbate his moods. At this point, he has decided he wants to change, but he feels he simply needs anger management. What do you think?
Thank you so much.
You are describing symptoms and behaviors commonly found in a stress-produced depression. While his anger and angry behaviors are the most obvious, the underlying features of a depression are clearly present. A high level of prolonged stress produces this type of depression. Symptoms include irritability, hypersensitivity, rumination (thinking too much), social withdrawal, taking everything in his environment personally (that mosquito is out to get him), loss of self-esteem (feels the business is a failure), a sense of helplessness, and being explosive verbally and behaviorally. If we imagine filming him with a videocamera, we’d see many signs of what I call “neurochemical agitation” which tells us that chemicals such as adrenalin are being released — the physical movements, loud talk, verbal abuse, red faced anger, etc.
This level of depression often prompts people to abuse alcohol in an attempt to calm down. However, alcohol works the opposite by actually disinhibiting him — causing his control over his behavior to decrease. Xanax, while helping with anxiety, had no effect on depression and when taken, will only make him “calmly depressed”. He would benefit from taking Xanax, but not on an as-needed basis. He needs to take is on a regular schedule to prevent outbursts. Taking a medication after the outburst is ineffective, like closing the garage door after your car has been stolen.
Anger management will not fix this situation. He would find improvement by using an antidepressant, perhaps in combination with Xanax and anger management or counseling. As we can tell by his verbal abuse and now physical contacts, his situation is getting worse. I would recommend returning to an antidepressant medication. He would need to take the medications as prescribed. One of the main reasons medications don’t work is noncompliance with the schedule. Some additional information on the treatment of depression:
Antidepressant medications work by slowly making more Serotonin (a neurotransmitter) available in the brain. Low levels of this brain neurotransmitter have been associated with depression, Obsessive-Compulsive Disorder (OCD), and eating disorders just to name a few conditions. These antidepressant medications typically take four to six weeks to show significant improvement. As treatment continues, depressive symptoms tend to disappear in a type of order. With treatment, the most recent symptoms — typically the most severe such as crying spells, mood instability, explosiveness, and increased brain speed — are the first to leave. The first symptoms of depression — the so-called “early warning signs” such as poor concentration, sleep problems, emotional numbness, social withdrawal, etc. — are typically the last to return to normal.
Individuals prescribed antidepressants are often concerned about the return of their happy, romantic, and warm-loving mood. These feelings require additional time to return to normal. The reason? Two feelings states can not be present at the same time. You can’t feel romantic in a pool filled with sharks. Depression, anxiety, panic, worry, fret, and agitation are very loud and intrusive emotions. These loud emotions easily overpower softer emotions such as romance, love, and warmth. When this happens, while we may feel better and have less depressive symptoms with treatment, our feelings of love and romance may require additional time to return. A total return to your non-depressed state may take several months, depending upon such factors as current stress level, medication dose, and the presence of other symptoms that may complicate your recovery such as anxiety, obsessive-compulsive or panic symptoms.
Other important factors in antidepressant treatment:
- The recovery is gradual. You’ll begin by having “good days”. Then several good days and a stressful evening or morning. Gradually you will have more good days and an occasional difficult time.
- Recovery is also related to the medication and dosage. Some nonpsychiatrists prescribe antidepressants at low or even “starter” doses. This will slow your recovery. If your family physician is providing a medication that is too low in dosage, you may need to seek out a psychiatrist who is experienced in using antidepressant medications.
- Recovery is also related to your current stress level. While severe stress creates depression, if the stress level remains high during treatment, recovery will be slower. If I have a surgical knee replacement, it will heal faster if I don’t place excessive use on the knee. If I have the surgery and then walk 15 miles per day on that knee, recovery is slower.
- If your current medication or treatment programs are not working well, don’t be afraid to switch antidepressant medications. 35% of individuals receiving antidepressant medications find it necessary to switch to a different antidepressant.
- Antidepressants can work too well. If you have been taking an aggressive dose of an antidepressant and you gradually find yourself too happy (elated, spending sprees, hypersexual behavior, no need for sleep, talkativeness, etc.), contact your physician immediately. Just like depression, the other side of this mood (hypomania) can be dangerous to you, your relationships, and your finances.
Recovery from depression is a gradual process — not an overnight one. Even when your normal mood returns, it is recommended that you continue your antidepressant until discontinued by your physician. Many people continue on a low, maintenance dose of their antidepressant for extended periods of time without difficulty. Questions regarding specific medications, side effects, and reactions with other medications should be directed to your physician.
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