Serotonergic antidepressant effects on aggressive, self-injurious and destructive/disruptive behaviours in intellectually disabled adults: a retrospective, open-label, naturalistic trial

Abstract

There is a growing body of evidence that serotonergic antidepressants are useful in the treatment of maladaptive behaviours in the intellectually disabled. However, not all studies have shown positive results due to lack of efficacy, tolerance development, and troublesome side-effects. The current study consisted of a review of the treatment response to a variety of serotonergic antidepressants, consisting of selective serotonin reuptake inhibitors (SSRIs ) (n = 36) and clomipramine (n = 2) in 38 institutionalized intellectually disabled adults (20 males, 18 females; mean age 45.6 yr, age range 18-74 yr). Those studied were treated for aggression, self-injurious behaviours, destructive/disruptive behaviours, depression/dysphoria, or a combination of these or other challenging behaviours. Most were receiving concurrent psychotropic and/or anticonvulsant medications. Effectiveness was determined by a retrospective review of the summaries of multidisciplinary Neuropsychiatric Behavioural Reviews (NBRs) in which global and specific maladaptive behaviours were rated on a 1- to 7-point scale, and by psychologists' ratings of target behaviours. Overall, statistically significant decreases in the ratings of global maladaptive behaviour and aggression, self-injurious behaviour, destruction/disruption and depression/dysphoria and in psychologists' ratings occurred in the subject group after the initiation of antidepressants. The results suggest that serotonergic antidepressants are useful in the treatment of challenging/maladaptive behaviours in the intellectually disabled.

Serotonin depletion counteracts sex differences in anxiety-related behaviour in rat

“…In the same vein, enhancement of serotonergic activity has been reported to decrease aggression in men (Cherek and Lane 2001;Choi-Kwon et al 2006;Coccaro and Kavoussi 1997;Janowsky et al 2005;McCloskey et al 2009) as well as the sex hormone-dependent irritability reported in the luteal phase of the menstrual cycle by women with premenstrual dysphoric disorder (Landén et al 2007;Yonkers et al 2008). Moreover, decreased libido and abolished or delayed orgasm are the most common longterm side effects of these compounds (Montejo-González et al 1997;Waldinger and Olivier 1998); the latter of these effects also having been utilized for therapeutic purposes (Moreland and Makela 2005).…”

Treatment of repeated self- injurious behaviour with naltrexone: a case report

“…Different modalities of treatment have been tried for selfinjurious behavior. Serotonergic antidepressants are useful in the treatment of self-injurious behaviors in intellectually disabled person (9). Atypical antipsychotics especially risperidone have been used for treatment of aggression and self-injurious behavior (10).…”

Behaviour disorders in children with an intellectual disability

“…Some patients respond to anticonvulsants such as topiramate or valproic acid (31). Fluoxetine and trazodone have also been used (32). However, the majority of studies on pharmacological treatment of SIB have been performed in adults or in children with autistic spectrum disorders (33).…”