Understanding and Preventing Violence, Volume 2: Biobehavioral Influences (1994)
Chapter: ANTIDEPRESSANTS
documented the strong sedative effects of neuroleptics and revealed their most significant long-term side effects. Tardive dyskinesias and dystonias may be managed by dosage adjustments and usage of depo formulations (e.g., Leventhal and Brodie, 1981; Itil, 1981). In a small subpopulation of individuals, the risk of hypotension or agranulocytosis limits the use of certain phenothiazines or the atypical neuroleptic, clozapine.
Concluding Statement
The neurobiologic mechanisms for the antiaggressive and violence-controlling effects of neuroleptic or antipsychotic drugs are linked to their action on dopaminergic and noradrenergic receptors (discussed earlier). These drugs fundamentally modulate the way in which antecedent and consequent events impact on behavior, and the way behavioral activities are initiated and patterned. The potent antiaggressive effects of antipsychotics appear to be part of the profound action of these drugs; they are not specific to aggressive and violent types of behavior. Given the lack of behavioral specificity and the risk of neurologic and autonomic side effects, neuroleptics should be used only in emergency situations. Novel drugs with selective action on dopamine receptor subtypes may feature more specific behavioral effects. These agents need to be investigated for their therapeutic effects in aggressive and violent individuals.
ANTIDEPRESSANTS
The potential common origin for aggressive, hostile, and violent acts and feelings and for depressive pathologies, particularly in those with suicidal tendencies, has been a long-standing postulate (e.g., Freud, 1917). During the past 15 years, low 5-HT concentrations and metabolite levels in brain and spinal cord as well as in blood platelets in subgroups of depressive patients with poor impulse control and in violent alcoholics have been interpreted as consistent with early psychoanalytic postulates (e.g., Asberg et al., 1987; Van Praag, 1982; see above). Recent efforts in antidepressant research have focused on the inhibition of uptake sites and receptor subtypes for serotonin, blurring the distinction between pharmacotherapies for certain types of anxiety and depression. The classic antidepressant drugs include such chemically diverse substances as imipramine-type tricyclics, monoamine oxidase inhibitors, and lithium.
