Abstract Theories with fourth-order derivatives, including the Lee–Wick finite QED model and quadratic gravity, have a better UV behavior, but the presence of negative metric ghost modes endangers unitarity. Noticing that the ghost acquires a complex mass by radiative corrections, Lee and Wick, in particular, claimed that such complex ghosts would never be created by collisions of physical particles because of energy conservation, so that the physical S-matrix unitarity must hold. We investigate the unitarity problem faithfully, working in the operator formalism of quantum field theory. When complex ghosts participate, a complex delta function (a generalization of the Dirac delta function) appears at each interaction vertex, which enforces a specific conservation law of complex energy. Its particular property implies that the naive Feynman rule is wrong if the four-momenta are assigned to the internal lines after taking account of the conservation law in advance. We show that complex ghosts are actually created and unitarity is violated in such fourth-order derivative theories. We also find a definite energy threshold below which ghosts cannot be created: The theories are unitary and renormalizable below the threshold.