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A friend who works at a psychiatric hospital told me that one evening several patients organized a rebellion and attempted to escape the building by use of force. While the staff worked to control the situation, one of the group's ringleaders punched a nurse in the nose. As the security guards restrained him, he turned his head and spit in their faces.
When practitioners at psychiatric hospitals have no safe alternative, they sometimes use drugs to mitigate the risk of, at best, destructive behavior, or, at worst, violence. This is nothing new. Doctors have used anti-psychotics and antidepressants like Haldol and lithium since the 1960s to decrease the danger of physical aggression.
While both studies and anecdotal evidence show that these drugs reduce the risk of violence, they also have side effects. They can induce confusion, drowsiness or numbing. Human studies of Haldol have pointed to a risk of cognitive decline and, frighteningly, macaques that took Haldol for two years lost 10 percent of their brain matter. Lithium has a risk of overdose. Importantly, as more doctors are prescribing lithium to children with behavior problems who may develop bipolar disorder, we don't know how it affects the developing brain. One study found that children taking lithium scored 7 to 8 points lower on a test of development compared to their siblings.
Meanwhile, many new drugs have come to the market since Haldol and lithium gained prominence that may offer similar benefits but with less risk. Drugs that target specific neurotransmitter systems—like GABA, the primary inhibitory neurotransmitter of the central nervous system, or serotonin, important for mood regulation—have proven effective at reducing aggression, and sometimes with reduced side effects.
As part of my graduate research, we tested the ability of a migraine medication, Zomig, to decrease aggression in a laboratory task. When subjects took a 5mg dose, they displayed less aggressive behavior compared to a placebo condition. The effect held even if we gave them alcohol and provoked them—two universal fuels of aggression. Zomig's potency lies in its specificity when acting in the brain. Research has long shown that serotonin levels play a primary role in aggression. More specifically, a class of receptors—serotonin 1B—change the likelihood of aggressive behavior when they're activated. Zomig specifically targets these receptors, allowing it to decrease aggression with minimal side effects.
Although FDA approved for treating migraines, Zomig hasn't yet been tested clinically for behavior. But because it shows promise in both human and mice laboratory studies, it may offer a novel, safe alternative to existing treatments for aggression.
Neuroscience has vastly improved our understanding of the brain's control of aggressive behavior, from the regions involved to the types of chemicals at play. By continuing to use older drugs, we may be missing opportunities to improve the quality of life for individuals with behavior problems that warrant medication.
Raising awareness about novel drugs or new uses for existing ones may help control destructive behavior while minimizing side effects. For patients, taking medications that don't numb your faculties has obvious benefits. For caretakers, decreasing the odds of a fist to the nose while doing your job seems like the least you could ask for. Ideally, we should all win. Here's hoping for that day to come. If hoping doesn't satisfy, we can always use a hand in the laboratory.
