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October 26th, 2010
09:51 AM ET

Is it normal to have anger issues after going on and off pain meds?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Tuesday, it's Dr. Charles Raison, a psychiatrist.

Question asked by Cookie of Texas

My husband had major surgery and while on pain meds in the hospital he started developing anger issues. They lowered his pain meds saying this was a side effect for some people. He is out of the hospital and no longer on any meds but he still seems to be unreasonable and angry much more than is typical for him. Is this normal? Is it due to the drugs? I feel like he has become someone other than the man I married.

Expert answer

I am very concerned about your husband's situation. I hope it has resolved in the period between when you wrote your question and my somewhat delayed answer. Let me use your situation as a chance to talk about how a psychiatrist (or at least this psychiatrist!) would try to figure out what is going on.

I think it is very important to start with the most serious/dangerous possibilities first, because if one of these turns out to be true then rapid action is definitely needed. So let's start by assuming that your husband is not usually an angry individual and that the anger really started with the administration of the pain medications. This is not uncommon, as the folks at the hospital told you. If it had gone away when the pain meds were stopped, or shortly thereafter, I'd have no further worries and my advice would be for your husband to avoid these types of medicines whenever possible.

But his odd, angry behavior has continued and that's what is worrisome. It suggests that the pain medications may have started something, but they can't be the whole story. Or it might not have been the pain meds - they might be a "red herring." It might have been something that happened during the surgery.

Let's assume (and of course I don't know) that your husband doesn't have a substance abuse problem, so it is very unlikely that he is secretly still taking the pain medications. Assuming this, there are really only two primary possibilities for his behavior. The first is that something medical or neurological has happened to him and this has changed his behavior. The most common examples of these sorts of things would be a stroke, the development of seizures or the new-onset of a glandular problem. The first thing I would do if I were in charge of the case would be to have doctors carefully check each of these possibilities.

If he turns out not to have one of these organic problems, then the next most likely thing is that something about the hospital experience has initiated a psychiatric problem, specifically a manic state - which would be the most common cause for behavior such as you describe. If he is talking rapidly, not sleeping and making risky and poor decisions, these would also be manic symptoms. But all these symptoms could also be caused by a new medical or neurological problem.

Finally, if your husband is older, it is possible that he was gradually developing a dementia that has been accelerated by the strain of the hospital experience.

I have no idea whether any of these possibilities would turn out to explain your husband's specific situation. The larger take-home point is that whenever an adult has a sudden personality change this is likely to reflect either a medical or psychiatric emergency. If you haven't done so please get your husband medical and/or psychiatric help immediately.


soundoff (30 Responses)
  1. c

    I'm no doctor, but I'm surprised you didn't mention the possibility of going under anesthesia being a possible culprit.
    My father had surgery many years ago, and we were told that this could happen. It did, and it lasted about 6 months.
    Anesthesia can do many things to the brain that we don't understand........and for some, it can be a LONG time before the effects wear off completely, even thought it is technically no longer in your system.

    October 26, 2010 at 10:24 | Report abuse | Reply
  2. Tosin Majoyeogbe

    From observation, people naturally have anger issues when they are experiencing pain. One thing she failed to mention, is if her husband is still experiencing pain. The next point to consider is if he had any anger issues prior to the surgery. If he's still in pain, then he's just responding to the pain by being easily irritable. Otherwise, the post anesthesia effect should be considered.

    October 26, 2010 at 10:38 | Report abuse | Reply
  3. kaci

    There are 2 drugs that cause these symptoms for me. One is cortisone. I get extremely angry and can't control it. They give me this medicine when I have hives. The second drug is "levo thyroxdine" for thryoid. Within a week of taking it I have hostile angry feelings that I can't control. I just can't take any form of synthroid drugs. I wish the FDA would warn people about drug effects on your systems.

    October 26, 2010 at 10:54 | Report abuse | Reply
  4. cookie

    It was my letter and here is the update: First, yes, he had anesthesia 3 times in a week and yes was in a great deal of pain and almost died. So there was stress to say the least. After about 6-8 weeks he seemed to turn the corner physically and emotionally. It has been about 3 months and he has been sweeter than he's been the whole time I've known him.
    I don't think his anger was the typical grumpiness due to not feeling well, there was something else going on.

    October 26, 2010 at 11:30 | Report abuse | Reply
    • Michelle

      I am glad you posted an update and that he is doing well.

      October 26, 2010 at 14:49 | Report abuse |
  5. cookie

    p.s. Thanks so much Dr Raison for your answer!

    October 26, 2010 at 11:32 | Report abuse | Reply
  6. Goldenlotus

    Let me first express an extreme sense of concern at the crass tone of some of the posts on this topic. This is yet another situation where it would be so beneficial if Western and Eastern Medicine would listen to one another and cooperate. Traditional Chinese Medicine associates emotions with various organ systems. Anger is the associated emotion when the liver is out of balance. Pharmaceuticals, anesthesia, pain meds, all have a huge affect on the liver. The liver has a huge function in balancing body chemistry. It's all inter-related, including brain chemistry.

    October 26, 2010 at 11:40 | Report abuse | Reply
    • c

      Yes! That makes total sense. I do wish we cooperated more with both kinds of medicine. I am fortunate to have a doctor that sees the value of both.

      October 26, 2010 at 12:10 | Report abuse |
  7. Katherine

    I was prescribed Vicodin for pain 6 years ago and I took it a couple of times and it made me really mean and I wanted to hurt people. I had to have my friend take my 6 year old until it wore off. I will NEVER take that drug again. It really scared me. I've had three surgeries in the last 12 months and I get off the opiates as soon as I can, within 2 days. The side effects are awful. But the doctor is right, As soon as the Vicodin wore off, I was fine, but it is a really scary side effect that no one warns you about.

    October 26, 2010 at 12:35 | Report abuse | Reply
  8. Mamudoon

    Cookie –

    You don't have to get into specifics on a public forum, but I can't help but wonder if your husband was given tramadol (Ultram). It's used as a pain reliever, but it also has a profound effect on your serotonin levels (similar to an antidepressant), and that can screw your mood up something fierce when you go off of it, even if you were only taking small amounts for a short period of time. I was prescribed tramadol to see if I could manage my pain with a non-narcotic medication, and I will never take it again. Aside from not working, I developed HUGE rage issues, anxiety, and suicidal thoughts when I tapered off of it. As I dug around the internet wondering what on earth was happening to me, I found that I'm far from the only person who experienced that. It takes a particularly long time to clear out of your system, as well – it's not like coming off of opiates, which have a much shorter withdrawal period.

    I hate coming off as one of those "avoid this evil drug!!" kind of people, but I think tramadol is just dangerous because doctors never discuss the antidepressant properties of it. Anyway, I'm glad your husband is doing better!

    October 26, 2010 at 12:38 | Report abuse | Reply
  9. Julie Labrouste

    An ex of mine had a severely aggressive reaction to MS Contin; he nearly hit me when there was no argument or anything going on; he had just taken it only minutes before he stormed down stairs and got in my face O.O And he was never one to do anything like that ever, let alone to me. That scared the tar out of me. He towers over me and was bristling; I tried to leave the house and he blocked the door. When he came down, he was mortified by his reaction and was extremely upset.

    October 26, 2010 at 12:41 | Report abuse | Reply
  10. M. De Phillipe

    Certainly it was the pills plus the fact that most males do not like
    to feel scared i.e. very ill. Men like to have the illusion that they
    are in control ,not out of control as with being sick or the loss of
    a job or mate.

    October 26, 2010 at 13:06 | Report abuse | Reply
  11. Nick

    I have a very enlightening story that might shed some light on this topic as well. I have Rheumatoid Arthritis. I have had this disease since I was roughly 10-12 years old. Since then I have been put on Prednisone and Methotrexate on and off (I say on and off because sometimes the disease will go into remission for 1-4 years, like now, I just went into remission the past couple of months, hopefully I get a few years). So, I would like to at least talk about Methotrexate and it's side effects.

    Methotraxate is pretty much medication only for those with Cancer or other serious diseases, 1 being RA. This drug will KILL your liver among soooo many other things. This drug has created massive rage inside of me that when I was younger, found it purely impossible to contain. I used to get in fights almost everyday after school and had no self control even in a civil classroom. I would yell at teachers/students/anyone else.... So about 1 and a half ago I was back on the drug and slowly filled back up with rage again. Since I am now older and know how the drug and the influences it leaves on me, I had a lot of self control. Problem is I would be forced to be very quiet or anti social at times, so I wouldn't go off on someone for no reason. This drug takes a toll on you and really tests your self control. I am glad my disease is back into remission, as I really do not want to have to go on this drug again. Yes, this drug is a miracle drug, really. I would be crippled and unable to get out of bed if I didn't have this drug. Now that I am off of it though (4-5 weeks now no Methotrexate), I am slowly feeling normal and calm again and it feels sooo good to not be angry 60=100% of the time. This drug makes you a raging bull and will dull your senses, so use at your own risk and research drugs more. I have done extensive research on this drug.

    In the end, I think about when my disease will come back out of remission. I ask myself "Will I take this drug when my disease is back?" I say hell no, but I know, if I cannot get out of bed or hold a cup of water, or dress myself, I will be forced to take this drug. It has me by the balls.

    I am 21 now and am living a normal-ish life. I have battled this cancer like disease halfl my life. This RA is not like regular arthritis at all, as this RA is full body and much more than just arthritis. Less than 1% of the popultaion have this rare disease.

    Good luck with choosing your medications but you must beware the side effects.

    ~Nick

    October 26, 2010 at 13:27 | Report abuse | Reply
    • Donna

      You are still very young, and probably at the peak of your testosterone. Hopefully the bad side effect will diminish as you age. And more hopefully, maybe some better treatments will be developed!

      October 26, 2010 at 14:17 | Report abuse |
    • Nick

      Exactly... Another thing to note, I look like I am 15-18 years old, very young. Very attractive too, though I barely see that and focus on my young trait as annoying... Too much attention my way, so I avoid people at times so I don't have eyes staring at me.

      October 26, 2010 at 15:17 | Report abuse |
  12. hj

    My wife started taking Lyrica for nerve damage associated with diabetes. Since then her moods changed to the point to where she has left me twice and I have had to ask her to leave once. We are at the point of a divorce and I'm wondering if anyone knows of any side effects that Lyrica may cause simiilar to what's being reported in the article above. She was the sweetest person I had met until the drugs. She also does take Vicodin, when the pain gets too intense for the Lyrica to manage.

    October 26, 2010 at 13:36 | Report abuse | Reply
    • MC

      Lyrica was the first med I was prescribed for my nerve pain. To put it mildly, my husband called me the Antichrist. I couldn't stop the anger or the crying jags. I gained weight on it and that made me angrier. The worse part was it didn't help with the pain no matter how high the dose. Add to that the fact that the active life I had always known was over and....let's just say I wasn't fun to be around.

      I shared all my fears (and anger) with my neurologist from the beginning. He listened, made suggestions, even gave me references to other professionals who could help me. He told me from the start he's here to help me and he's proven that over the last five years. By trial and error we have come up with a combination of meds that work for me. I get the pain relief I need with side effects I can deal with.

      It's up to your wife to be an active participant in her health care. She needs to go her doctor and discuss the side effects of the meds she's taking and any possible interaction with other meds she may be on. She can tell him this is not working she wants to try something else. I hope she's seeing a neurologist with extensive experience dealing with neuropathy. If not, get her to one. Research the doctors in your area before making an appt. Find one that best suits her needs. Read patient reviews. If a doc doesn't take the time to listen or doesn't seem to care, find one who does. Don't give up.

      I wish you the best.

      October 26, 2010 at 17:49 | Report abuse |
  13. Goldenlotus

    Read the package inserts. "May cause unusual changes in behavior." I am convinced that both of my parents met their demise due to "side effects" of pharmaceutical medications. Not every person has the same physiological / biochemical make up. There is no "one size fits all" and if you press the point with most (not all) physicians, they begin spouting risk / benefit statistics. My mother was diabetic. After she started a new medication, my father came home from work to find her aiming a pellet rifle out the second story window of our house, convinced that a massive flock of crows was decimating her vegetable garden...called the MD who said "Not possible that it's the meds." Called the pharmacist who said, "Absolutely, can be the meds." Stopped the medication, stopped the hallucinations. Properly monitored pharmaceuticals save lives, but caution is warranted. When Integrative Western Medicine and Eastern Medicine work together there can be great benefit, not necessarily miracles, but great benefit.

    October 26, 2010 at 14:02 | Report abuse | Reply
  14. Michelle

    Years ago women in my office were taking Metabolife to lose weight and a few were successful. I took it and went from relaxed and amiable to constant feeling of road rage whether in my car or not. We all put up with a horrendous boss and I was a single mom and needed my job. It took all the restraint I had not to curse him this day. I vowed never to take any kind of diet pills again. I am embarrassed that I did this.

    October 26, 2010 at 14:57 | Report abuse | Reply
  15. lzahart

    I think it is bordering on medically irresponsible that the dr answering this question did not mention withdrawal. Depending on body chemistry, it doesn't take very long for people to become medically addicted, even if they aren't psychologically AND even if they are taking the drug as prescribed. If the medicine is not properly tapered, and counseling for the withdrawal is not given, then it can very easily lead to depression– which in many men presents as anger or rage. So while his initial anger may be attributable to the drugs, his anger now may be because of the hopelessness and loss of control many people feel when they stop taking medicine to control the pain and are left with nothing to do with their emotions. I suggest your husband find a good pain clinic in your area, which will have resources to deal with this without making your husband feel like his is a drug addict by choice, Good luck.

    October 26, 2010 at 16:09 | Report abuse | Reply
  16. terri

    I had a similar reaction to a pain killer after I had my wisdom teeth removed. They made sure to have a person drive you home but never told me I would go off and out of control like I did. I never took that stuff again. There should be package labeling that is clear and it should be required to tell you of the affects and encourage you to share that with a partner, parent or care giver. Some of those estimates of up to 6 months are correct. It does take time.

    October 26, 2010 at 16:09 | Report abuse | Reply
  17. Rose

    Good Luck to you, Nick. And, Donna, that was such a nice comment for you to make to Nick. I agree with you.

    RE: the initial problem – I think the anesthesia had much to do w/this man's anger. I'm glad his situation has improved.

    October 26, 2010 at 17:02 | Report abuse | Reply
  18. Chris

    QUOTE: "If you haven't done so please get your husband medical and/or psychiatric help immediately."
    It's interesting that you separate medical and psychiatric help. The distinction that you make seems to perpetuate the public misconception that psychiatric issues are not true "medical" issues. I'm surprised hearing this from a psychiatrist. You *did* graduate from *medical* school, correct?

    October 26, 2010 at 17:11 | Report abuse | Reply
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