Fluoxetine and impulsive aggressive behavior in personality-disordered subjects

Arch Gen Psychiatry. 1997 Dec;54(12):1081-8. doi: 10.1001/archpsyc.1997.01830240035005.


Background: Evidence of an inverse relationship between central serotonergic (serotonin [5-hydroxytryptamine]) system function and impulsive aggressive behavior has been accumulating for more than 2 decades. If so, pharmacological enhancement of serotonin activity should be expected to reduce impulsive aggressive behavior in subjects in whom this behavior is prominent.

Methods: A double-blind, placebo-controlled trial of the selective serotonin-uptake inhibitor fluoxetine hydrochloride was conducted in 40 nonmajor-depressed, nonbipolar or schizophrenic, DSM-III-R personality-disordered individuals with current histories of impulsive aggressive behavior and irritability. Measures included the Overt Aggression Scale-Modified for Outpatients, Clinical Global Impression Rating of Improvement, and several secondary measures of aggression, depression, and anxiety.

Results: Fluoxetine, but not placebo, treatment resulted in a sustained reduction in scores on the Irritability and Aggression subscales of the Overt Aggression Scale-Modified for Outpatients that was first apparent during months 2 and 3 of treatment, respectively. Fluoxetine was superior to placebo in the proportion of "responders" on the Clinical Global Impression Rating of Improvement: first at the end of month 1, and then finally demonstrating a sustained drug-placebo difference from the end of month 2 through the end of month 3 of treatment. These results were not influenced by secondary measures of depression, anxiety, or alcohol use.

Conclusion: Fluoxetine treatment has an antiaggressive effect on impulsive aggressive individuals with DSM-III-R personality disorder.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aggression / drug effects*
  • Double-Blind Method
  • Fluoxetine / analogs & derivatives
  • Fluoxetine / blood
  • Fluoxetine / pharmacokinetics
  • Fluoxetine / therapeutic use*
  • Humans
  • Impulsive Behavior / blood
  • Impulsive Behavior / drug therapy*
  • Impulsive Behavior / physiopathology
  • Male
  • Patient Dropouts
  • Personality Disorders / drug therapy*
  • Personality Disorders / physiopathology
  • Personality Disorders / psychology
  • Placebos
  • Psychiatric Status Rating Scales
  • Serotonin / physiology
  • Treatment Outcome


  • Placebos
  • Fluoxetine
  • Serotonin
  • norfluoxetine