Table 1.

Pharmacological Treatment of Aggressive Behavior

Drug	Neurotransmitters involved	Target population	Observations
Typical antipsychotics26-28	Dopaminergic antagonists (mainly D2)	ID, DB, psychotic, schizophrenia, bipolar disorders	Extrapyramidal side effects when receptor occupancy exceeds 80%
Atypical antipsychotics6,29-31	Multiple: dopaminergic and serotonergic antagonists	ID, DB, ASD, dementia; psychotic	Risperidone and aripiprazole are FDA approved in ASD patients. Clozapine use is related to lower mortality in schizophrenia
Antidepressants32-35	Selective serotonin reuptake inhibitors	ASD, ID, PTSD, unipolar depression, Alzheimer's disease, psychosis	The use of this class of drugs has been limited due to the side effects that occur at higher doses
Alpha 2 agonists36-38	Alpha-2 adrenergic receptor agonists	ASD, DB	Changes in blood pressure, decreased activity, sedation
Mood stabilizers (lithium)39-42	Unknown. Possibly by interaction with glutamate receptors and/or with K+, Na+, Ca2+ channels	ID, DB, ADHD, bipolar aggressive patients, prison inmates	High risk for adverse drug reactions
Psychostimulants (methylphenidate)43-46	Dopamine and norepinephrine agonists	DB, ADHD, ODD	Delay in weight gain and growth; cardiovascular risk
Anticonvulsants (divalproex sodium)47-49	Increases GABA concentration and/or inhibition of voltage-sensitive sodium channels	ADHD, ODD, DB, schizophrenia	Low-quality evidence to support the use of this drug

ADHD = attention deficit/hyperactivity disorder; ASD = autism spectrum disorder; DB = disruptive behavior; ID = intellectual disability; ODD = oppositional defiant disorder; PTSD = posttraumatic stress disorder.