Angry in the Morning

A patient asked if I would see husband who suffered from fibromyalgia. Her greater concern, however, was his anger and hatefulness.Their marriage, she told me, was in jeopardy.

Rick was 35 and employed in advertising. He had fibromyalgia for several years and none of his doctors had been able to help him. He was getting by with ibuprofen, but barely. He acknowleged that his anger and irritability was a problem but, strangely, it was present only in the morning. It usually dissipated by mid afternoon. His pain also. Another issue of concern to him was his slowness of thought and lack of mental focus. This also in the morning. By the afternoon he acquired great powers of concentration and creativity. His best work, indeed his only work, occurred between the hours of3 and 11 PM

His lack of mental focus was quite evident on a follow up visit. It occurred about 8AM and my patient's inability to recall, comprehend, and relate meaningfully to me was startling. I suspected adult attention deficit disorder, but the temporal pattern, present in the morning and not in the afternoon, was most unusual. Nonetheless, most everything I see is unusual so I pursued my inquiries. He responded that he did indeed experience very vivid dreams that were  frightening to him. He ofter awoke from them anxious,angry, and, on occasion briefly paralyzed, unable to move or speak.

I have written before about the bipolar spectrum, a constellation of disorders including attention deficiency, narcolepsy ( vivid dreams and sleep paralysis), and mood shifting bipolar disorder. My young advertising executive had it in spades, and in a most unusual temporal pattern. Distracted and angry ( a common bipolar symptom) in the morning and energized and creative(bipolar mania???) in the evening.

I treated him first with the stimulant amphetamine (Adderall). His dreams became more pleasant and his morning inattentiveness abated somewhat but he remained painful and, he acknowleged, quite irritable in the mornings. I added the opiate methadone ( I have written much about the role of methadone in the painful bipolar) and his improvement was sudden and total. He told me on a recent visit that on one occasion he forgot to take his morning methadone dose and nearly got in a fight with a coworker. Realizing what was happening, he returned home to take his pills, the back to gainful morning work, mentally focused and without anger and pain ( also, I believe, a common bipolar symptom).

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Anonymous Posts: 4
Reply #2 on : Fri May 20, 2011, 01:11:30
Unfortunately it is the family that surrounds the painful patient that suffers the most.
From the beginning you were just as intent on restoring the "husband" and "Father" that I wanted to be, as you were about curing the pain that brought me to you.
I encourage anyone who suffers with chronic pain or lives with someone who does to read your books.
Restoration of a life worth living is possible.
Thank you for listening.
Last Edit: May 24, 2011, 12:55:53 by robertcochran  
Terri Posts: 4
Dr. Cochrane
Reply #1 on : Tue November 02, 2010, 09:46:02
I just wanted to mention that until I read the statement above I had not connected the crippling anger I felt all the time with my bi-polar mania. Now I can actually grasp that it's not me it's this illness. I honestly thought I was just becoming a cranky old lady, but not so. I usually take my methadone and all is great. My poor family I'm sure just thought I was a natural born bitchy soul or was having PMS, but not so. I found myself taking my methadone only when I was in pain but now I realize I have to take it every day like I'm supposed to in order to feel OK. I am going to show my husband this, bless his heart he puts up with all my moods but lately it seems I just want to fight over everything and my anger is so deep. I will defintely start taking my medicine everyday as scheduled, I don't know why this did not dawn on me earlier. Thank you Dr. Cochran once again for being the best doctor ever and listening to me, you really did save my life. Sincerely your friend T.G.
Last Edit: November 08, 2010, 12:33:22 by robertcochran