Understanding and Preventing Violence, Volume 2: Biobehavioral Influences (1994)
Chapter: ANXIOLYTICS
Sheard and Marini, 1978). These therapeutic effects were obtained with lithium doses that did not produce cognitive impairment or physiological toxicity.
Concluding Statement
Antidepressants that produce their therapeutic effect as a result of noradrenergic or serotonergic uptake blockade are relatively weak and inconsistent antiaggressive agents. The only possible exception may be beneficial effects in patients with compulsive-obsessive disorder in whom serotonergic uptake blockers reduce aggressive behavior.
The preclinical and clinical evidence establishes lithium as an effective long-term antiaggressive substance. Due to its poor compliance the antiaggressive effects are more readily seen in institutionalized individuals in whom medication delivery is supervised and blood levels are monitored. The major limitations of lithium therapy are the potential for toxic reactions in the thyroid and renal systems, nausea, and complete lack of therapeutic response. Only a more satisfactory understanding of the mechanisms by which lithium produces its antiaggressive effects would aid in diagnosing lithium responders more readily.
ANXIOLYTICS
The management of aggressive and violent behavior with antianxiety drugs emerged as a therapeutic option within the past three decades when benzodiazepines and serotonin receptor agonists became the most effective and widely used substances for generalized anxiety disorders. Earlier generations of sedative drugs with antianxiety effects such as alcohol and barbiturates are highly problematic in their actions on violent and aggressive behavior because of their aggression-heightening properties in a considerable proportion of individuals (e.g., Miczek, 1987; Miczek et al., in this volume).
Ever since benzodiazepines were introduced in the early 1960s and prior to an adequate understanding of their mechanisms of action, they have been successfully used in clinical practice not only for primary indications in anxiety and sleep disorders, muscle relaxation and sedation, but also for the acute management of aggressive and violent individuals. A new era of benzodiazepine research began in 1977 with the biochemical identification of the benzodiazepine receptor in several organs, including brain (Braestrup
