A Cochrane review [Abstract] 1 included 14 studies with a total of 672 subjects. Sodium valproate/divalproex was superior to placebo for outpatient men with recurrent impulsive aggression, for impulsively aggressive adults with cluster B personality disorders, and for youths with conduct disorder, but not for children and adolescents with pervasive developmental disorder. Carbamazepine was superior to placebo in reducing acts of self-directed aggression in women with borderline personality disorder, but not in children with conduct disorder. Oxcarbazepine was superior to placebo for verbal aggression and aggression against objects in adult outpatients. Phenytoin was superior to placebo on the frequency of aggressive acts in male prisoners and in outpatient men including those with personality disorder, but not on the frequency of 'behavioral incidents' in delinquent boys.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and more than 20% loss to follow up), by inconsistency (heterogeneity in interventions and outcomes and variability in results across studies), and by imprecise results (limited study size for each comparison).
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