If you find that your angry outbursts are negatively affecting your relationships with family, friends, co-workers and even complete strangers, it's probably time to change the way you express your anger.
Here are some tips to get your anger under control:
Take a "time out." Count to 10 before reacting or leave the situation altogether.
Do something physically exerting. Physical activity can provide an outlet for your emotions, especially if you're about to erupt. Go for a walk or a run, swim, lift weights or shoot baskets, for example.
Find ways to calm and soothe yourself. Practice deep-breathing exercises, visualize a relaxing scene, or repeat a calming word or phrase to yourself, such as "take it easy." You can also listen to music, paint, journal or do yoga.
Express your anger as soon as possible so that you aren't left stewing. If you can't express your anger in a controlled manner to the person who angered you, try talking to a family member, friend, counselor or another trusted person.
Think carefully before you say anything so that you don't end up saying something you'll regret.
Work with the person who angered you to identify solutions to the situation.
Use "I" statements when describing the problem to avoid criticizing or placing blame. For instance, say "I'm upset you didn't help with the housework this evening," instead of, "You should have helped with the housework." To do otherwise will likely upset the other person and escalate tensions.
Don't hold a grudge. Forgive the other person. It's unrealistic to expect everyone to behave exactly as you want.
Use humor to defuse your anger, such as imagining yourself or the other person in silly situations. Don't use sarcasm, though — it's just another form of unhealthy expression.
Keep an anger log to identify the kinds of situations that set you off and to monitor your reactions.
You can practice many of these strategies on your own. But if your anger seems out of control, is hurting your relationships or has escalated into violence, you may benefit from seeing a psychotherapist or an anger management professional. Role playing in controlled situations, such as anger management classes, can help you practice your techniques.
Keep at it
It may take some time and intense effort to put these tips into practice when you're facing situations that typically send you into a rage. In the heat of the moment, it can be hard to remember your coping strategies.
You may need to keep something with you that serves as a reminder to step back from the situation and get your anger under control. For instance, you may want to keep a small, smooth stone in your pocket or a scrap of paper with your tips written down. With due diligence, these anger management techniques will come more naturally and you'll no longer need such reminders.
Tuesday, October 30, 2007
Saturday, October 20, 2007
Anger management: Recognize and understand unhealthy behaviors
You've probably heard the joke: "I went to a fight and a hockey game broke out." Certainly, it seems like there are more brawls than ever at sporting events these days, that you're lucky if you've never been subjected to road rage, and that you may have to tip-toe around coworkers who seem constantly ready to explode.
But it's not anger itself that's a problem — it's how you handle it. Robert T. Zackery is a licensed independent clinical social worker at Mayo Clinic, Rochester, Minn., who provides counseling and runs anger management classes. Here, he offers insights into the nature of anger, when it can be helpful, how to manage it, and what to do when you're confronted by someone whose anger is out of control.
What is anger?
Anger is a feeling of displeasure or hostility. It's a normal, healthy emotion, just like any other feeling you have.
Anger has several components:
Psychological. This is the emotional component of anger, how you feel, such as sadness, disappointment or frustration.
Physiological. This is how your body responds to anger, such as muscle tension or an increase in heart rate and blood pressure as your body releases adrenaline — the fight-or-flight hormone.
Cognitive. This is what you think as you experience anger, such as acknowledging that it's OK to be frustrated, or, on the other end, thinking that the world is out to get you or that your spouse "never" does what you ask.
In essence, anger is a warning bell that tells you something is wrong in a situation. It's a natural response to perceived threats.
So it's not "bad" to feel angry?
No, being angry isn't a bad or negative thing. Being angry can motivate people to listen to your concerns. It can prevent others from walking all over you. And it can motivate people to change larger societal issues. It's how you handle your anger that can be a problem.
Why, then, do some people think that being angry is unacceptable?
Some people are uncomfortable with the expression of anger. A lot of it depends on their own personal experiences with anger. For instance, if they were in abusive situations or if they grew up in a household where anger was used to control their family, any sign of anger can make them anxious. They can feel intimidated by anger, even if it's expressed in an appropriate manner. They may think "nice" people don't get angry.
What causes people to become angry?
There's usually an activating event — something in particular that sets you off, such as a disagreement at work, being stuck in traffic or not being able to get through to an actual person on the phone. Some people may be angry about their own personal circumstances, such as financial problems.
Most people don't just walk around feeling mad all the time, though, unless it was a learned behavior. People aren't born angry.
You said it's how people handle their anger that's important. What are the ways of handling anger, and what's the healthiest way?
There are two basic ways to handle anger:
Expression. This is conveying your anger. Expression occurs along a continuum, from having a reasonable, rational discussion to erupting into out-of-control violence. It's the difference between talking to someone or picking up a baseball bat and hitting them.
Suppression. This is trying to hold in or ignore your anger. You may think you shouldn't be angry or that you'll lose control if you let yourself feel any anger. The danger in this passive approach is that you may not protect yourself when the need arises. On the other hand, you may become passive-aggressive, where you don't express your anger assertively or directly but scheme to retaliate because you haven't learned how to express anger constructively. Trying to suppress your anger can lead to such health problems as headaches, stress, depression or high blood pressure.
Expressing yourself in an assertive — not an aggressive — manner is the healthiest approach to handling anger. You state your concerns and needs clearly and directly, without hurting others or trying to exert power over them.
Why do some people snap, exploding into rages even over seemingly minor irritations?
Reactions to anger really aren't instantaneous, even if it may appear that someone suddenly "snaps." When someone explodes with anger, there are actually a lot of feelings behind that prior to reaching that boiling point. What happens, though, is that people don't stop to examine their feelings before they explode.
Your personal history feeds your reactions to anger. That's why some people react so angrily to certain situations, like losing a parking space, while others take it in stride. You may have built up years of feeling unheard, ignored, sad, frustrated or disrespected. From the activating event that initially triggers your anger, you move along a continuum where you feel a number of things, such as intensifying agitation or irritation, and then your personal history comes into play and you may explode, especially if you don't step back to think about where your anger is heading. Also, if you were taught that being angry was negative, you may never have learned how to express anger appropriately.
How can you stop your anger from turning into a violent outburst?
Out-of-control anger is a learned behavior, so you have to unlearn it. Consider, for instance, someone who was in the military and basically taught to kill. Then he leaves the military, but with every confrontation or challenge, he goes back into that military role and responds aggressively — not assertively, but with aggression or hostility. He has to realize that no one is trying to fight with him, and that his reaction is out of proportion to the situation.
Some anger management techniques he can practice include:
Self-talk to remind himself he's not in the military anymore and to keep himself aware of his reactions.
Walking away from the situation until he calms down.
Remembering to treat other people like he'd want to be treated.
Agreeing to disagree, and leaving it at that.
He may also need professional help or a qualified anger management class to help him unlearn these behaviors.
What is an anger management class, and how does it work?
An anger management class is a way to teach people how to express their anger in a controlled, healthy way. We teach people about what anger is, how to recognize their anger triggers, how to become aware of their own feelings of anger, and how to keep their anger under control. We also discuss what other feelings they may have going on, such as depression. We can do this individually, with spouses or families, or in groups.
So, for the person who was in the military, for example, we would work with him on realizing that he doesn't need to yell and scream and get aggressive when he's angry. We'd also work with him on issues he may have with his upbringing, such as being in an abusive household.
How do you know if you might benefit from an anger management class?
Not everyone who gets angry needs an anger management class. You may get ticked that your television remote control doesn't work and throw it across the room. Do you have an anger management issue if you do that? Probably not.
But if you have run-ins with the police, you physically harm someone or you try to intimidate someone with your anger, you could probably benefit from an anger management class.
Some people blame their reactions on others, saying things like, 'You bring out the worst in me.' Is that a valid excuse?
Someone can make you angry, but how you express that anger is your responsibility. In a marriage or family, does your spouse or your kids know which buttons to push that will set you off? Sure they do. They know your vulnerable spots.
This happens to me with my teenage daughter sometimes. She may repeatedly ask to go out with friends I don't want her to be with, and I get mad at her. But what I'm really feeling is afraid for my child. Is her behavior making me angry? Yes, sometimes it is. But you have to remember that we're responsible for our own feelings and reactions to what other people do. Recognize that you have a conflict and see how you can handle it appropriately.
Can anger harm your health?
There is evidence that shows inappropriately expressing anger can be harmful. Whether you're overly passive and keep your anger pent up, whether you're prone to violent outbursts or whether you're quietly seething with rage, you may have headaches, sleep difficulties, high blood pressure or digestive problems. There's even some evidence that stress and hostility related to anger can lead to heart attacks. That's another reason it's important to learn how to express anger constructively and appropriately — it's good for your health.
It seems as if so many people are on edge these days, ready to explode or actually launching into violent rages, like at sporting events. Is society becoming angrier?
Many people today are faced with multiple stressors — bills, drugs, peer pressure, racial conflicts, health care issues, war. There's a lot of stress in society in general. There are so many things to feel threatened about, and some people respond in a negative way. Or maybe they're just not satisfied with life; they're not content. And they haven't learned how to handle their anger constructively.
But it's not entirely unique to modern-day society. I experienced a road-rage situation 25 years ago. I pulled up to a stop sign and so did another person. I felt I was there first so went ahead. Well, she followed me around the block several times, and when I went and parked, she pulled up next to me so close that I couldn't even open my car door. And then she started screaming at me that I'd cut her off. I finally said I'd call the police and she drove away.
What can you do if you're confronted by someone whose anger is out of control?
Usually the most rational thing to do, if possible, is to just walk away. If you stay, you risk it escalating into violence. It's important to take reasonable precautions to protect yourself if leaving the situation is difficult or impossible, and to not engage the other person in a manner that's likely to provoke an escalation in their angry behavior.
That's not to say you should never confront someone. If someone is doing something you don't want them to do, and you confront them about it, you now have a conflict. You have to know how you're going to handle that conflict, though. Size up the person you're confronting, and be ready to protect yourself, especially if it's a stranger.
But it's not anger itself that's a problem — it's how you handle it. Robert T. Zackery is a licensed independent clinical social worker at Mayo Clinic, Rochester, Minn., who provides counseling and runs anger management classes. Here, he offers insights into the nature of anger, when it can be helpful, how to manage it, and what to do when you're confronted by someone whose anger is out of control.
What is anger?
Anger is a feeling of displeasure or hostility. It's a normal, healthy emotion, just like any other feeling you have.
Anger has several components:
Psychological. This is the emotional component of anger, how you feel, such as sadness, disappointment or frustration.
Physiological. This is how your body responds to anger, such as muscle tension or an increase in heart rate and blood pressure as your body releases adrenaline — the fight-or-flight hormone.
Cognitive. This is what you think as you experience anger, such as acknowledging that it's OK to be frustrated, or, on the other end, thinking that the world is out to get you or that your spouse "never" does what you ask.
In essence, anger is a warning bell that tells you something is wrong in a situation. It's a natural response to perceived threats.
So it's not "bad" to feel angry?
No, being angry isn't a bad or negative thing. Being angry can motivate people to listen to your concerns. It can prevent others from walking all over you. And it can motivate people to change larger societal issues. It's how you handle your anger that can be a problem.
Why, then, do some people think that being angry is unacceptable?
Some people are uncomfortable with the expression of anger. A lot of it depends on their own personal experiences with anger. For instance, if they were in abusive situations or if they grew up in a household where anger was used to control their family, any sign of anger can make them anxious. They can feel intimidated by anger, even if it's expressed in an appropriate manner. They may think "nice" people don't get angry.
What causes people to become angry?
There's usually an activating event — something in particular that sets you off, such as a disagreement at work, being stuck in traffic or not being able to get through to an actual person on the phone. Some people may be angry about their own personal circumstances, such as financial problems.
Most people don't just walk around feeling mad all the time, though, unless it was a learned behavior. People aren't born angry.
You said it's how people handle their anger that's important. What are the ways of handling anger, and what's the healthiest way?
There are two basic ways to handle anger:
Expression. This is conveying your anger. Expression occurs along a continuum, from having a reasonable, rational discussion to erupting into out-of-control violence. It's the difference between talking to someone or picking up a baseball bat and hitting them.
Suppression. This is trying to hold in or ignore your anger. You may think you shouldn't be angry or that you'll lose control if you let yourself feel any anger. The danger in this passive approach is that you may not protect yourself when the need arises. On the other hand, you may become passive-aggressive, where you don't express your anger assertively or directly but scheme to retaliate because you haven't learned how to express anger constructively. Trying to suppress your anger can lead to such health problems as headaches, stress, depression or high blood pressure.
Expressing yourself in an assertive — not an aggressive — manner is the healthiest approach to handling anger. You state your concerns and needs clearly and directly, without hurting others or trying to exert power over them.
Why do some people snap, exploding into rages even over seemingly minor irritations?
Reactions to anger really aren't instantaneous, even if it may appear that someone suddenly "snaps." When someone explodes with anger, there are actually a lot of feelings behind that prior to reaching that boiling point. What happens, though, is that people don't stop to examine their feelings before they explode.
Your personal history feeds your reactions to anger. That's why some people react so angrily to certain situations, like losing a parking space, while others take it in stride. You may have built up years of feeling unheard, ignored, sad, frustrated or disrespected. From the activating event that initially triggers your anger, you move along a continuum where you feel a number of things, such as intensifying agitation or irritation, and then your personal history comes into play and you may explode, especially if you don't step back to think about where your anger is heading. Also, if you were taught that being angry was negative, you may never have learned how to express anger appropriately.
How can you stop your anger from turning into a violent outburst?
Out-of-control anger is a learned behavior, so you have to unlearn it. Consider, for instance, someone who was in the military and basically taught to kill. Then he leaves the military, but with every confrontation or challenge, he goes back into that military role and responds aggressively — not assertively, but with aggression or hostility. He has to realize that no one is trying to fight with him, and that his reaction is out of proportion to the situation.
Some anger management techniques he can practice include:
Self-talk to remind himself he's not in the military anymore and to keep himself aware of his reactions.
Walking away from the situation until he calms down.
Remembering to treat other people like he'd want to be treated.
Agreeing to disagree, and leaving it at that.
He may also need professional help or a qualified anger management class to help him unlearn these behaviors.
What is an anger management class, and how does it work?
An anger management class is a way to teach people how to express their anger in a controlled, healthy way. We teach people about what anger is, how to recognize their anger triggers, how to become aware of their own feelings of anger, and how to keep their anger under control. We also discuss what other feelings they may have going on, such as depression. We can do this individually, with spouses or families, or in groups.
So, for the person who was in the military, for example, we would work with him on realizing that he doesn't need to yell and scream and get aggressive when he's angry. We'd also work with him on issues he may have with his upbringing, such as being in an abusive household.
How do you know if you might benefit from an anger management class?
Not everyone who gets angry needs an anger management class. You may get ticked that your television remote control doesn't work and throw it across the room. Do you have an anger management issue if you do that? Probably not.
But if you have run-ins with the police, you physically harm someone or you try to intimidate someone with your anger, you could probably benefit from an anger management class.
Some people blame their reactions on others, saying things like, 'You bring out the worst in me.' Is that a valid excuse?
Someone can make you angry, but how you express that anger is your responsibility. In a marriage or family, does your spouse or your kids know which buttons to push that will set you off? Sure they do. They know your vulnerable spots.
This happens to me with my teenage daughter sometimes. She may repeatedly ask to go out with friends I don't want her to be with, and I get mad at her. But what I'm really feeling is afraid for my child. Is her behavior making me angry? Yes, sometimes it is. But you have to remember that we're responsible for our own feelings and reactions to what other people do. Recognize that you have a conflict and see how you can handle it appropriately.
Can anger harm your health?
There is evidence that shows inappropriately expressing anger can be harmful. Whether you're overly passive and keep your anger pent up, whether you're prone to violent outbursts or whether you're quietly seething with rage, you may have headaches, sleep difficulties, high blood pressure or digestive problems. There's even some evidence that stress and hostility related to anger can lead to heart attacks. That's another reason it's important to learn how to express anger constructively and appropriately — it's good for your health.
It seems as if so many people are on edge these days, ready to explode or actually launching into violent rages, like at sporting events. Is society becoming angrier?
Many people today are faced with multiple stressors — bills, drugs, peer pressure, racial conflicts, health care issues, war. There's a lot of stress in society in general. There are so many things to feel threatened about, and some people respond in a negative way. Or maybe they're just not satisfied with life; they're not content. And they haven't learned how to handle their anger constructively.
But it's not entirely unique to modern-day society. I experienced a road-rage situation 25 years ago. I pulled up to a stop sign and so did another person. I felt I was there first so went ahead. Well, she followed me around the block several times, and when I went and parked, she pulled up next to me so close that I couldn't even open my car door. And then she started screaming at me that I'd cut her off. I finally said I'd call the police and she drove away.
What can you do if you're confronted by someone whose anger is out of control?
Usually the most rational thing to do, if possible, is to just walk away. If you stay, you risk it escalating into violence. It's important to take reasonable precautions to protect yourself if leaving the situation is difficult or impossible, and to not engage the other person in a manner that's likely to provoke an escalation in their angry behavior.
That's not to say you should never confront someone. If someone is doing something you don't want them to do, and you confront them about it, you now have a conflict. You have to know how you're going to handle that conflict, though. Size up the person you're confronting, and be ready to protect yourself, especially if it's a stranger.
Thursday, October 11, 2007
Anger management: How angry are you?
Do you slam down the phone when faced with endless computerized voice prompts? Have you gotten into a shouting match with a stranger over a parking space at the mall? Ever put your fist through the wall after an argument with your spouse?
Although anger is a natural emotion, it may be getting the best of you. Instead of expressing your anger in a healthy and assertive way, you may be expressing it in a hostile, aggressive manner — a manner that could lead to violence.
Here are some points to consider when assessing whether you express your anger in a healthy or unhealthy manner.
Determine your level of anger
Anger itself isn't bad. Expressed appropriately, anger can be healthy. It can help protect you from dangerous situations, energize you to resolve problems or lead to sociocultural reforms, for instance.
Sure, everyday frustrations, impatience and resentment can all cause your temper to flare. For many people, these are fleeting moments. They're able to take these moments in stride and quickly return to a sense of calm without exploding.
But if your blood boils after minor irritations — such as losing that coveted parking space — or you're constantly seething, you may need to get your anger under control. Anger that's out of control can be destructive, leading to problems in your relationships, at work, in your general enjoyment of life and with your health. You may even be arrested or face other legal problems.
Just how angry are you? Study this chart to determine a barometer of your anger. See if the words describe your behavior or thoughts over the past week. Then rate each word on this scale:
0 = Not at all accurate
1 = Somewhat accurate
2 = Moderately accurate
3 = Very accurate
4 = Extremely accurate
Determining your level of anger
Words Your rating
Angry
Bitter
Rebellious
Spiteful
Deceived
Annoyed
Furious
Resentful
Bad-tempered
Ready to fight
Yelling
Frustrated
Disappointed
If you have several 2, 3 and 4 ratings, you may need professional help in learning to handle anger in a healthier way. Talk to your health care providers about resources, such as counseling or anger management classes.
Examine your anger patterns
Anger responses can become habitual. That is, you may respond automatically to a situation that makes you angry, with little pause to think about your reactions. You may even surprise yourself by the intensity of your reactions.
How do you express your anger? Consider these questions to assess your anger responses:
Do you express anger in a way that overwhelms you and others?
Do you get angry more often than most people you know?
Do you get angrier than is necessary?
Do you use threatening language or gestures?
Do you get angry enough to hit, throw or kick things or living beings?
Do you stay angry for hours?
Do you hide angry feelings from others or try to suppress your feelings?
Do you use alcohol or drugs to calm your rage?
Do you experience physical reactions such as muscle tension or a racing heart when you get angry?
Does expressing your anger usually leave you feeling better about yourself and the person who angered you?
Identify the ways you express anger to help you determine if you need to change the ways you respond to upsetting situations. You may react too aggressively or even too passively. In either case, you can learn new anger patterns to replace old, unhealthy habits.
Tips to control your anger
If your level of anger is high or you tend to express anger in an unhealthy way, make plans to deal with your anger.
Aim for constructive expressions of your anger
Anger management is not about stopping you from expressing your anger entirely. It's OK to feel angry. In fact, trying to suppress or deny your anger can lead to a host of physical complaints, such as headaches, depression, stress, and sleeping or eating difficulties. It can also lead you to erupt into violent behavior if your anger has been simmering without an outlet.
The key, though, is to express your anger in an assertive, controlled way. Managing anger effectively can benefit you and those around you. Your health may improve, you'll feel better about yourself, and your relationships with others may improve. So get your anger under control, before it controls you.
Although anger is a natural emotion, it may be getting the best of you. Instead of expressing your anger in a healthy and assertive way, you may be expressing it in a hostile, aggressive manner — a manner that could lead to violence.
Here are some points to consider when assessing whether you express your anger in a healthy or unhealthy manner.
Determine your level of anger
Anger itself isn't bad. Expressed appropriately, anger can be healthy. It can help protect you from dangerous situations, energize you to resolve problems or lead to sociocultural reforms, for instance.
Sure, everyday frustrations, impatience and resentment can all cause your temper to flare. For many people, these are fleeting moments. They're able to take these moments in stride and quickly return to a sense of calm without exploding.
But if your blood boils after minor irritations — such as losing that coveted parking space — or you're constantly seething, you may need to get your anger under control. Anger that's out of control can be destructive, leading to problems in your relationships, at work, in your general enjoyment of life and with your health. You may even be arrested or face other legal problems.
Just how angry are you? Study this chart to determine a barometer of your anger. See if the words describe your behavior or thoughts over the past week. Then rate each word on this scale:
0 = Not at all accurate
1 = Somewhat accurate
2 = Moderately accurate
3 = Very accurate
4 = Extremely accurate
Determining your level of anger
Words Your rating
Angry
Bitter
Rebellious
Spiteful
Deceived
Annoyed
Furious
Resentful
Bad-tempered
Ready to fight
Yelling
Frustrated
Disappointed
If you have several 2, 3 and 4 ratings, you may need professional help in learning to handle anger in a healthier way. Talk to your health care providers about resources, such as counseling or anger management classes.
Examine your anger patterns
Anger responses can become habitual. That is, you may respond automatically to a situation that makes you angry, with little pause to think about your reactions. You may even surprise yourself by the intensity of your reactions.
How do you express your anger? Consider these questions to assess your anger responses:
Do you express anger in a way that overwhelms you and others?
Do you get angry more often than most people you know?
Do you get angrier than is necessary?
Do you use threatening language or gestures?
Do you get angry enough to hit, throw or kick things or living beings?
Do you stay angry for hours?
Do you hide angry feelings from others or try to suppress your feelings?
Do you use alcohol or drugs to calm your rage?
Do you experience physical reactions such as muscle tension or a racing heart when you get angry?
Does expressing your anger usually leave you feeling better about yourself and the person who angered you?
Identify the ways you express anger to help you determine if you need to change the ways you respond to upsetting situations. You may react too aggressively or even too passively. In either case, you can learn new anger patterns to replace old, unhealthy habits.
Tips to control your anger
If your level of anger is high or you tend to express anger in an unhealthy way, make plans to deal with your anger.
Aim for constructive expressions of your anger
Anger management is not about stopping you from expressing your anger entirely. It's OK to feel angry. In fact, trying to suppress or deny your anger can lead to a host of physical complaints, such as headaches, depression, stress, and sleeping or eating difficulties. It can also lead you to erupt into violent behavior if your anger has been simmering without an outlet.
The key, though, is to express your anger in an assertive, controlled way. Managing anger effectively can benefit you and those around you. Your health may improve, you'll feel better about yourself, and your relationships with others may improve. So get your anger under control, before it controls you.
Tuesday, October 2, 2007
Alpha-2 receptor blockers
Certain brain chemicals called neurotransmitters are associated with depression, including the neurotransmitters serotonin (ser-oh-TOE-nin) and norepinephrine (nor-ep-ih-NEF-rin). Research suggests that abnormalities in neurotransmitter activity can affect mood and behavior.
Instead of inhibiting the reabsorption of certain neurotransmitters as other antidepressants do, alpha-2 receptor blockers prevent neurotransmitters from binding with nerve cell receptors called alpha-2 receptors. This indirectly increases the levels of norepinephrine and serotonin in the brain, which may improve and elevate mood.
Mirtazapine (Remeron, Remeron Soltab) is the only alpha-2 receptor blocker approved by the Food and Drug Administration specifically to treat depression. Its generic name is followed by available brand names in parentheses. Mirtazapine (mir-TAZ-a-peen) is available as a pill and as a tablet that dissolves on your tongue (Remeron Soltab).
Side effects and safety concerns
Side effects of alpha-2 receptor blockers include:
Sedation
Weight gain
Dry mouth
Dizziness
Lightheadedness
Thirst
Muscle or joint aches
Constipation
Increased appetite
Increased cholesterol
Because of a potential drug interaction, don't take mirtazapine with another type of antidepressant called a monoamine oxidase inhibitor (MAOI). You may have increased drowsiness if you take mirtazapine with other medications or substances that also cause drowsiness, such as antihistamines, sedatives or alcohol.
In addition, in rare circumstances, mirtazapine can cause a potentially dangerous drop in white blood cell counts, which can make you vulnerable to infection. Talk to your doctor if you develop a sore throat, fever, inflammation of the mouth, flu-like symptoms or other signs of infection.
In some cases, antidepressants may be associated with worsening symptoms of depression or suicidal thoughts or behavior, particularly early in treatment or when you change your dosage. Be sure to talk to your doctor about any changes in your symptoms. You may need more careful monitoring at the beginning of treatment or upon a change in treatment, or you may need to stop the medication if your symptoms worsen.
Instead of inhibiting the reabsorption of certain neurotransmitters as other antidepressants do, alpha-2 receptor blockers prevent neurotransmitters from binding with nerve cell receptors called alpha-2 receptors. This indirectly increases the levels of norepinephrine and serotonin in the brain, which may improve and elevate mood.
Mirtazapine (Remeron, Remeron Soltab) is the only alpha-2 receptor blocker approved by the Food and Drug Administration specifically to treat depression. Its generic name is followed by available brand names in parentheses. Mirtazapine (mir-TAZ-a-peen) is available as a pill and as a tablet that dissolves on your tongue (Remeron Soltab).
Side effects and safety concerns
Side effects of alpha-2 receptor blockers include:
Sedation
Weight gain
Dry mouth
Dizziness
Lightheadedness
Thirst
Muscle or joint aches
Constipation
Increased appetite
Increased cholesterol
Because of a potential drug interaction, don't take mirtazapine with another type of antidepressant called a monoamine oxidase inhibitor (MAOI). You may have increased drowsiness if you take mirtazapine with other medications or substances that also cause drowsiness, such as antihistamines, sedatives or alcohol.
In addition, in rare circumstances, mirtazapine can cause a potentially dangerous drop in white blood cell counts, which can make you vulnerable to infection. Talk to your doctor if you develop a sore throat, fever, inflammation of the mouth, flu-like symptoms or other signs of infection.
In some cases, antidepressants may be associated with worsening symptoms of depression or suicidal thoughts or behavior, particularly early in treatment or when you change your dosage. Be sure to talk to your doctor about any changes in your symptoms. You may need more careful monitoring at the beginning of treatment or upon a change in treatment, or you may need to stop the medication if your symptoms worsen.
Male depression: Don't ignore the symptoms
Are you irritable, isolated and withdrawn? Do you find yourself working all the time, drinking too much alcohol, using street drugs or seeking thrills from risky activities?
If so, perhaps you're being chased by what Winston Churchill called his "black dog" — male depression. Churchill attempted to ward off his black dog with compulsive overwork and large amounts of brandy. For male depression, the coping strategy may be reckless driving, risky sex or shutting yourself off from the world.
But none of these can keep male depression at bay for long. Even worse: Men with depression are at an increased risk of suicide.
Male depression often undiagnosed
Each year, depression affects about 6 million American men and 12 million American women. But these numbers may not tell the whole story. Because men may be reluctant to discuss male depression with a health care professional, many men with depression may go undiagnosed, and consequently untreated.
Some men learn to overvalue independence and self-control during childhood. They're taught that it's "unmanly" to express common feelings and emotions often associated with depression, such as sadness, uncertainty or a sense of hopelessness. They tend to see illness — especially mental illness — as a threat to their masculinity. So men may deny or hide their problems until a partner's insistence or a catastrophic event, such as job loss or arrest, forces them to seek treatment.
When they visit their health care professional, men are more likely to focus on physical complaints — headaches, digestive problems or chronic pain, for example — than on emotional issues. As a result, the connection between such symptoms and male depression may be overlooked. And even if they're diagnosed with depression, men may resist mental health treatment. They may worry about stigma damaging their careers or about losing the respect of family and friends.
Symptoms of male depression
In both men and women, common signs and symptoms of depression include feeling down in the dumps, sleeping poorly, and feeling sad, guilty and worthless. Men with depression, however, have bouts of crying less often than do women with depression.
Other symptoms of male depression often include:
Anger and frustration
Violent behavior
Losing weight without trying
Taking risks, such as reckless driving and extramarital sex
Loss of concentration
Isolation from family and friends
Avoiding pleasurable activities
Fatigue
Loss of interest in work, hobbies and sex
Alcohol or substance abuse
Misuse of prescription medication
Thoughts of suicide
In addition, men often aren't aware that physical symptoms, such as headaches, digestive disorders and chronic pain, can be symptoms of male depression.
Job stress a common trigger of male depression
Whether in men or in women, the precise cause of depression isn't known. Researchers believe depression is the result of a combination of genetics, your thought processes and your social environment. Everyone, for instance, is susceptible to depression in the wake of a major life stress, such as the end of an important relationship, the death of a loved one, moving or financial problems.
Some research suggests that for men, job-related stress may also play an important role in male depression. Some job characteristics that may be associated with male depression include:
Lack of control over your responsibilities
Unreasonable demands for performance
Conflicts with supervisors or co-workers
Lack of job security
Night-shift work
Excessive overtime
More time than you'd like spent away from home
Wages that don't reflect the level of responsibility
When male depression goes untreated
Like other men, you may feel that your depression symptoms aren't severe. You may believe that you should be able to just get over them or tough them out. You may try to deny them, ignore them or blunt them by drinking too much alcohol or working longer hours. But left untreated, male depression symptoms can disrupt your life in many ways and leave you chronically unhappy and miserable.
Depression can also affect your health. For instance, it can keep your stress response continually activated, a state that can damage many organs, including the heart. Depression may even shorten your life. In a given year, men with depression are more than twice as likely as men without depression to die of any cause. Women with depression also have an increased risk of dying, compared with women without depression, but the difference is not as great as it is in men. Although the reasons for this difference are unclear, men with depression may be more likely to engage in self-destructive behavior — from excessive drinking to reckless driving to suicide — that may contribute to it.
Depression also increases your risk of divorce and your children's risk of developing depression themselves. At work, male depression makes you less productive, limits your earning potential and increases your risk of losing your job.
Suicide and male depression
Although women are twice as likely to have depression, men are four times as likely to suffer its worst consequence: suicide. Starting in adolescence, men are far more likely than women to take their own lives. Older men, particularly white men over age 85, have the highest suicide rate. Although women attempt suicide more often than men do, men are more likely to complete suicide.
Men are more likely to use more lethal means in suicide attempts, such as guns, which partly accounts for their higher rate of suicide. But other factors also are involved. One such factor may be their tendency to move from suicidal thoughts to suicidal actions faster than women. Men take an average of just 12 months to go from contemplating suicide to attempting suicide. In contrast, it takes women about 42 months. During this time, men are less likely than women to show warning signs, such as talk of suicide. Because this window of opportunity is so short, family and mental health professionals may have little chance to recognize a man's depression and intervene.
Treatment and self-care for male depression
If you or someone close to you is considering suicide, seek help immediately from your doctor, the nearest hospital emergency room or emergency services (911).
If you suspect you have depression, schedule a physical examination with your family doctor or primary health care professional. Conditions such as a viral infection, thyroid disorder and low testosterone levels can produce symptoms similar to male depression. If your doctor rules out such conditions as a cause of your symptoms, the next step may be a depression screening. Treatment for male depression may include antidepressant medications, psychotherapy or both.
Self-care strategies also may help. These include:
Setting realistic goals and prioritizing tasks
Spending time with supportive family and friends
Engaging in activities you enjoy, such as exercise, movies, ball games or fishing
Delaying important decisions, such as changing jobs or getting married or divorced, until your depression symptoms improve
If so, perhaps you're being chased by what Winston Churchill called his "black dog" — male depression. Churchill attempted to ward off his black dog with compulsive overwork and large amounts of brandy. For male depression, the coping strategy may be reckless driving, risky sex or shutting yourself off from the world.
But none of these can keep male depression at bay for long. Even worse: Men with depression are at an increased risk of suicide.
Male depression often undiagnosed
Each year, depression affects about 6 million American men and 12 million American women. But these numbers may not tell the whole story. Because men may be reluctant to discuss male depression with a health care professional, many men with depression may go undiagnosed, and consequently untreated.
Some men learn to overvalue independence and self-control during childhood. They're taught that it's "unmanly" to express common feelings and emotions often associated with depression, such as sadness, uncertainty or a sense of hopelessness. They tend to see illness — especially mental illness — as a threat to their masculinity. So men may deny or hide their problems until a partner's insistence or a catastrophic event, such as job loss or arrest, forces them to seek treatment.
When they visit their health care professional, men are more likely to focus on physical complaints — headaches, digestive problems or chronic pain, for example — than on emotional issues. As a result, the connection between such symptoms and male depression may be overlooked. And even if they're diagnosed with depression, men may resist mental health treatment. They may worry about stigma damaging their careers or about losing the respect of family and friends.
Symptoms of male depression
In both men and women, common signs and symptoms of depression include feeling down in the dumps, sleeping poorly, and feeling sad, guilty and worthless. Men with depression, however, have bouts of crying less often than do women with depression.
Other symptoms of male depression often include:
Anger and frustration
Violent behavior
Losing weight without trying
Taking risks, such as reckless driving and extramarital sex
Loss of concentration
Isolation from family and friends
Avoiding pleasurable activities
Fatigue
Loss of interest in work, hobbies and sex
Alcohol or substance abuse
Misuse of prescription medication
Thoughts of suicide
In addition, men often aren't aware that physical symptoms, such as headaches, digestive disorders and chronic pain, can be symptoms of male depression.
Job stress a common trigger of male depression
Whether in men or in women, the precise cause of depression isn't known. Researchers believe depression is the result of a combination of genetics, your thought processes and your social environment. Everyone, for instance, is susceptible to depression in the wake of a major life stress, such as the end of an important relationship, the death of a loved one, moving or financial problems.
Some research suggests that for men, job-related stress may also play an important role in male depression. Some job characteristics that may be associated with male depression include:
Lack of control over your responsibilities
Unreasonable demands for performance
Conflicts with supervisors or co-workers
Lack of job security
Night-shift work
Excessive overtime
More time than you'd like spent away from home
Wages that don't reflect the level of responsibility
When male depression goes untreated
Like other men, you may feel that your depression symptoms aren't severe. You may believe that you should be able to just get over them or tough them out. You may try to deny them, ignore them or blunt them by drinking too much alcohol or working longer hours. But left untreated, male depression symptoms can disrupt your life in many ways and leave you chronically unhappy and miserable.
Depression can also affect your health. For instance, it can keep your stress response continually activated, a state that can damage many organs, including the heart. Depression may even shorten your life. In a given year, men with depression are more than twice as likely as men without depression to die of any cause. Women with depression also have an increased risk of dying, compared with women without depression, but the difference is not as great as it is in men. Although the reasons for this difference are unclear, men with depression may be more likely to engage in self-destructive behavior — from excessive drinking to reckless driving to suicide — that may contribute to it.
Depression also increases your risk of divorce and your children's risk of developing depression themselves. At work, male depression makes you less productive, limits your earning potential and increases your risk of losing your job.
Suicide and male depression
Although women are twice as likely to have depression, men are four times as likely to suffer its worst consequence: suicide. Starting in adolescence, men are far more likely than women to take their own lives. Older men, particularly white men over age 85, have the highest suicide rate. Although women attempt suicide more often than men do, men are more likely to complete suicide.
Men are more likely to use more lethal means in suicide attempts, such as guns, which partly accounts for their higher rate of suicide. But other factors also are involved. One such factor may be their tendency to move from suicidal thoughts to suicidal actions faster than women. Men take an average of just 12 months to go from contemplating suicide to attempting suicide. In contrast, it takes women about 42 months. During this time, men are less likely than women to show warning signs, such as talk of suicide. Because this window of opportunity is so short, family and mental health professionals may have little chance to recognize a man's depression and intervene.
Treatment and self-care for male depression
If you or someone close to you is considering suicide, seek help immediately from your doctor, the nearest hospital emergency room or emergency services (911).
If you suspect you have depression, schedule a physical examination with your family doctor or primary health care professional. Conditions such as a viral infection, thyroid disorder and low testosterone levels can produce symptoms similar to male depression. If your doctor rules out such conditions as a cause of your symptoms, the next step may be a depression screening. Treatment for male depression may include antidepressant medications, psychotherapy or both.
Self-care strategies also may help. These include:
Setting realistic goals and prioritizing tasks
Spending time with supportive family and friends
Engaging in activities you enjoy, such as exercise, movies, ball games or fishing
Delaying important decisions, such as changing jobs or getting married or divorced, until your depression symptoms improve
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