Medications for Intermittent Explosive Disorder

SSRIs are first-line, especially fluoxetine.

🔹 Why fluoxetine? It was studied the most. Why? Who knows.

🔹 Does it work? Clinicians can expect about 66% of patients to respond.

🔹 How it works: SSRIs reduce impulsive aggression

When IED doesn’t respond to SSRIs… the following medications are used in order of preference based on research and effectiveness.

Second-Line Medications (for SSRI-resistant IED):
🔹 Phenytoin
🔹 Oxcarbazepine (or Carbamazepine)

🔬 What’s the Evidence?
🔹Phenytoin: A systematic review of 7 trials found it significantly reduces impulsive aggression.
🔹Oxcarbazepine: A 10-week trial showed a 62% response rate, compared to 25% on placebo.

Third-Line Medications (for refractory IED):
🔹 Lamotrigine
🔹 Topiramate
🔹 Valproate
🔹 Lithium

📊 Response Rates:
🔹Second-line meds: Can help up to 60% of patients.
🔹Third-line meds: 25-50% of refractory cases may respond.