Can stimulant medications cause irritability or anger?

From the Guidelines

Stimulant drugs can cause anger as a side effect, as evidenced by the potential to trigger irritability, hostility, and aggressive behavior in some individuals, particularly at higher doses or with prolonged use 1.

Key Points to Consider

• The most recent and highest quality study, published in 2019, highlights the importance of monitoring for adverse effects, including emotional changes, when prescribing stimulant medications 1.
• Stimulants can increase levels of neurotransmitters like dopamine and norepinephrine in the brain, which can heighten emotional reactivity and lower the threshold for frustration.
• People with pre-existing anger management issues or certain mental health conditions may be more susceptible to this side effect.
• If experiencing increased anger while taking prescribed stimulants, it is essential to consult a healthcare provider immediately to adjust dosage, switch medications, or recommend behavioral strategies to manage these emotional changes.

Important Considerations for Healthcare Providers

• When prescribing stimulant medications, healthcare providers should be aware of the potential for anger and other emotional changes as side effects.
• Regular monitoring of patients taking stimulant medications is crucial to identify any adverse effects early on and adjust treatment plans accordingly.
• A thorough medical history, including any pre-existing mental health conditions or anger management issues, should be taken before initiating stimulant medication therapy.
• Healthcare providers should also be aware of the potential for rebound hypertension after abrupt discontinuation of certain medications, such as guanfacine and clonidine, and taper them off instead of stopping suddenly 1.

From the FDA Drug Label

Aggression Aggressive behavior or hostility is often observed in children and adolescents with ADHD, and has been reported in clinical trials and the postmarketing experience of some medications indicated for the treatment of ADHD Although there is no systematic evidence that stimulants cause aggressive behavior or hostility, patients beginning treatment for ADHD should be monitored for the appearance of, or worsening of, aggressive behavior or hostility Anxiety, psychosis, hostility, aggression, and suicidal or homicidal ideation have also been observed with CNS stimulants abuse and/or misuse

• Stimulant drugs may be associated with aggressive behavior or hostility, although there is no systematic evidence that they cause it.
• Patients beginning treatment for ADHD should be monitored for the appearance of, or worsening of, aggressive behavior or hostility.
• Abuse and/or misuse of CNS stimulants, including methylphenidate and amphetamine, can result in overdose and death, and may cause anxiety, psychosis, hostility, aggression, and suicidal or homicidal ideation 2 3.

From the Research

Stimulant Drugs and Anger

• There is limited research directly linking stimulant drugs to anger [ 4, 5 ].
• However, some studies suggest that stimulant use disorder can lead to a range of individual and public health issues, including increased risk of overdose deaths [ 6 ].
• Misuse of stimulants has been associated with dangers such as psychosis, myocardial infarction, cardiomyopathy, and even sudden death [ 7 ].
• Psychostimulants have been shown to improve emotional dysregulation and lability, and oppositional and conduct symptoms in individuals with ADHD [ 8 ].
• While there is some evidence that psychostimulants may improve outcomes in those with treatment-resistant depression, reduce negative symptoms and improve cognitive performance in schizophrenia, the relationship between stimulant drugs and anger is not well-established [ 8 ].

Adverse Effects of Stimulant Drugs

• Stimulant misuse can lead to serious consequences, including psychosis, myocardial infarction, cardiomyopathy, and even sudden death [ 7 ].
• The use of stimulant medications can have short-term and long-term adverse effects, including increased risk of overdose deaths [ 6 ].
• Long-term safety studies and education on the health risks associated with misuse of stimulants are imperative [ 7 ].

Treatment Strategies for Stimulant Use Disorder

• Contingency management programs have been shown to be effective in treating stimulant use disorder [ 5 ].
• There is insufficient evidence to support the clinical use of psychostimulants for the treatment of stimulant use disorder [ 5 ].
• High-quality primary research focused on the role of psychostimulant medications for the treatment of stimulant use disorder is needed [ 5 ].