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best med for anger? (road rage?)


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i have ocd but also know i have a pretty hard time with anger on top of my anxiety. and it is very difficult around where i live because there are a LOT of aggressive drivers. my sensitivity is set really really high for anybody tailgating me or just driving aggressively. its fucking hell to drive where i live, and i've pretty much gotten to the point where i don't want to drive even the simples errand because i "know" somebody is going to tailgate me or i'm going to experience something that will irritate me. i know some of its environmental, and some of its just the way my brain works.

what AC works best for those with anger problems? i finally got my pdoc to prescribe lamictal a second time around but i'm not really sure it will be enough, or targets the right area. i know i've heard lithium is good for anger, and am willing to try it, but i already have no thyroid as it is and don't necessarily need something messing with my thyroid levels, but if it will work better than lamictal i'll take it. any advice would help.

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The pat reply is Depakote. It's the one that's been looked at a lot, at any rate (as has lithium, as you know). That's going to pose its own problems with Lamictal, though. Yes, lithium works for a lot of people. Yes, lithium can drag your thyroid down. This is why we have serum monitoring and levothyroxine...

People talk about Topamax a lot for ragefulness. It seems to be one that goes either way. It works quite well sometimes when the rage is secondary to a clear temporal lobe injury or lesion, but it can also make one a raging bitch. Some people love it beyond all other drugs. Most people don't find that it makes them super-brilliant, which is an issue if you're driving. I get lost driving home sometimes.

Carbamazepine can be quite helpful for anger/rage. Also quite sedating at first; problem, if you're driving. Also will really jack up the clearance of your Lamictal.

Lyrica and Neurontin can be disinhibiting, both in the literature and in the anecdata. On a totally anecdata basis, I think I'd be wary of these. My personal experience with Lyrica thus far has been that it has not diminished my anger one bit. In fact, I've been rather prone to 'meeting rage.'

Overall, I don't think it's a matter so much of "which drug," with the caveat re: Lyrica/Neurontin as above, as it is a matter of getting the disorders under control. Is this anger fear-based or predatory? Are you angry because someone could have hurt you / is too close to your space, or are you angry because they are impeding your rapid forward progress? That might help you and your psychiatrist figure out what you need to target and where to go from here. If it's more anxiety/fear-driven than mania/goal-driven, that's useful to know. (I think I wrote that coherently...)

Also, this may be the last thing you want to read right now - sorry if it's grating. Do you work with a therapist at all on your thinking about this, the "knowing somebody will tailgate you" and that this will be horrible? Or on being mindful when things like tailgating are happening? Because it seems like that might be kind of helpful, even for just a few skills-type visits, just to give you some more tools to handle this.

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Or go to Seattle or the Hampton Roads area.

However, on topic, I've found that Topamax works well for me (as Silver pointed out). *IF* I lay off the coffee. Yeah, I still cuss out anyone who gets too close to my bumper and anyone who gets really stupid on the road, but I'm not nearly as bad as I used to be. Oh boy, was I a basket case before... a raging loony.

Of course, that could be because I live in a little one-horse town now, and not a major metropolitan area.

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the Hampton Roads area.

I've lived and worked in the Hampton Roads area, and it isn't as bad as South Florida.

Still, laying off the morning coffee until you get to your destination is probably good advice.

I'm also thinking that stress management exercises would help more than a med adjustment. It just seems to me that the ACs and AAPs that would help with anticipatory anxiety and situational irritation might also add a bit too much sedation if the traffic really is that bad.

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The Hampton Roads area didn't *used* to be that bad until a couple of years ago - when I left last year it was horrible. I mean horrible... just as bad as Florida. Now, I've never lived in South Florida, but Jacksonville was bad enough for me, and I visited in-laws in South Florida.

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Is this anger fear-based or predatory? Are you angry because someone could have hurt you / is too close to your space, or are you angry because they are impeding your rapid forward progress? That might help you and your psychiatrist figure out what you need to target and where to go from here. If it's more anxiety/fear-driven than mania/goal-driven, that's useful to know. (I think I wrote that coherently...)

Also, this may be the last thing you want to read right now - sorry if it's grating. Do you work with a therapist at all on your thinking about this, the "knowing somebody will tailgate you" and that this will be horrible? Or on being mindful when things like tailgating are happening? Because it seems like that might be kind of helpful, even for just a few skills-type visits, just to give you some more tools to handle this.

the anger is definitely fear based. i'm a pretty calm person on the road and give the people ahead of me a lot of space. but i have like a sixth sense about the people behind me and if they are going to try and pass me or tailgate me, and i think i've just become more and more sensitized to it over the past year. i think its part of the ocd - low threshold for 'threat', but its really aggravating. i've tried different techniques in my own head over the past year: ignore it - treat it like an ocd threat, distract yourself with music . . . nothing has worked much. my amygdala seems to think its pretty important i know these things every time, even when the person is not that close.

(i'll have to find a link) but i printed out a page from dr. amens brain scans that shows ocd can be pretty close to road rage. in both case there's cingulate gyrus overactivity - causing difficulty shifting attention, and also left temporal lobe activity in road rage. so maybe something that targets that would help. in any case i have a few more drugs to think about than just lamictal and lithium, so i appreciate it.

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The other thing to talk to your psychiatrist about might be beta-blockers, if you haven't gone that route and if you don't have major contraindications. My mom has OCDish tendencies (hoarding, some checking, but she generally keeps it all within parameters most of the time) and can't deal with tailgaters, similar to what you're talking about. ADs haven't gone well. B-blockers, however, are OK for her in lower doses and turn down the signal enough that she can use her skills and generally keep it together (in the city, at rush hour.) She only takes them in shorter-acting forms before drive time for the commute, and it seems to turn down the conditioned response enough that she's OK for other driving. Some effects on both anxiety and aggression. This is probably second- or third-line for most folks. Still, keep it on your list, maybe. Pindolol or propranolol are the usual ones for anxiety.

Although I did learn how to cuss like a champ when I rode in the car with my mom as a kid. So that was helpful. Thanks, Ma!

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