Q. I have a problem that I need to resolve with my anger. I am 43, married and teetering on the edge of separation from not controlling my anger. I have always had a quick temper and had difficulty controlling it. It seems like when I try to control it, its like someone dieting or cutting back on smoking, when you lose control it is worse since you have been trying to control it. My anger is worse with my direct family members and especially my wife. Arguments are generally the start. When the arguments continue, I get frustrated, raise my voice which generally escalates through the argument and so on. I have tendencies to break things. I have grabbed and pushed my wife to try to get control of the argument. My thoughts are that my wife provokes me which she thoroughly disagrees with. My last argument this weekend was from a third party and my wife was extremely upset. It was not a good situation. I did not grab my wife but did damage some furniture and the police were called.

I have decided to move out of the house to get some space and possibly lessen the exposure to my wife. I have a problem since I am self employed and my wife works in the business.

I have seen a marriage counselor and talked with him about this problem. We have not gotten anywhere yet. I haven't been back for a few months. I went to a Psychiatrist and was put on a medication that made me drowsy. I drive for a living and have to be careful with medication. I also went to a supposedly premium psychiatrist in the Cleveland clinic and it was a waste of time. Basically he told me to do things to relieve stress such as activities. I don't disagree but I think there is more to be done.

This problem is similar with my brother and I guess my grandfather was diagnosed with explosive anger disorder 50 years age. When this occurs, I can feel racing of my adrenaline and it definitely wears me out later in the day It is a serious situation since my anger lets my mind wander of violent actions. Generally to never are they carried out. Mostly the problem is the arguments with my wife but I do not like to have the negative thoughts.

A. Without a full psychiatric evaluation, it is difficult to tell if medications would help, or what kinds to use. Anger and rage have been shown to benefit from a number of medications including the SSRIs, SNRIs, nefazodone, lithium, carbamazepine (Tegretol), valproate (Depakote), and buspirone (BuSpar). I would lean toward one of the first three groups if sedation is an issue. The first three all provide for a better quality of life, because if any work, you will need to stay on them for the foreseeable future.