We review alternative perspectives of anxiety viewed along the normal - abnormal continuum , as well as the frameworks of somatic and psychic anxiety. Classification of irritability and aggression is limited by the lack of diagnoses in DSM3R, terminology confusion and unavailability of marketed drugs for aggression. Drugs for these indications should preferably be non-sedative, not induce dependence, be safe and have limited drug interactions, particularly in specialized groups such as addicts, medically ill and geriatric patients. Irritability is an especially difficult and common problem in the elderly, yet there are no approved agents for aggression or irritability. Alcohol, bromides, barbiturates, meprobamate and the benzodiazepines have all had their problems.
Benzodiazepines have no place in irritability.
Legitimate alternatives exist such as antidepressant in anxiety, and beta-adrenergic blockers and azapirones in both anxiety and irritability. Psychopharmacology is rapidly approaching the age of specialized receptorology and serotonin subtypes play a major role in management of both anxiety and depression. Irritability is an early target symptom of response with low-dose buspirone in generalized anxiety disorder. This data requires adequate controlled studies as buspirone as the only marketed azapirone is approved for use only in anxiety and mixed anxiety depressive states.