A significant ADHD symptom that is commonly poorly controlled with psychostimulants is irritability. This suggests that at least in this subpopulation a partially different biochemical mechanism is involved. Exploration of aggression spectrum concepts such as anger, aggression, hostility, irritability and impulsivity are compromised by the general equivalent use of these terms, measuring difficulties, lack of research in the area and particularly no current diagnostic framework for aggression in DSM 3R or DSM-IV, with consequently no FDA approved drugs for aggression. All treatments being therefore innovative psychopharmacotherapy. The only selective group for serotonin 1A in therapeutic doses is the azapirones.
Animal models suggest the azapirones are potent anti-aggressive agents.
This should be via their specific serotonin 1A partial agonist effects at postsynaptic doses or specific full agonist effects at the autoreceptor level in lower doses. The only currently marketed azapirone is buspirone. Irritability is an early target symptom of response with buspirone in generalized anxiety disorder possibly implying persistent low-dose effects. Moreover, buspirone improves concentration. This data requires adequate controlled studies.