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

• Published in: The international journal of neuropsychopharmacology Vol. 8; no. 1; pp. 37 - 48
• Main Authors: Janowsky, David S., Shetty, Mahesh, Barnhill, Jarrett, Elamir, Belal, Davis, John M.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.03.2005; Oxford University Press
• Subjects: Adolescent; Adult; Aged; Aggression - drug effects; Antidepressive Agents - therapeutic use; Attention Deficit and Disruptive Behavior Disorders - drug therapy; Attention Deficit and Disruptive Behavior Disorders - psychology; Clomipramine - adverse effects; Clomipramine - therapeutic use; Comorbidity; Female; Humans; Institutionalization; Intellectual Disability - drug therapy; Intellectual Disability - psychology; Longitudinal Studies; Male; Mental Disorders - drug therapy; Mental Disorders - psychology; Middle Aged; Outcome Assessment (Health Care) - statistics & numerical data; Patient Care Team; Psychometrics - statistics & numerical data; Retrospective Studies; Self-Injurious Behavior - drug therapy; Self-Injurious Behavior - psychology; Serotonin Agents - adverse effects; Serotonin Agents - therapeutic use; Serotonin Uptake Inhibitors - adverse effects; Serotonin Uptake Inhibitors - therapeutic use; Social Behavior Disorders - drug therapy; Social Behavior Disorders - psychology; Violence - prevention & control; Violence - psychology; mental retardation; antidepressants; SSRIs; Aggression; self-injurious behaviour
• ISSN: 1461-1457; 1469-5111
• DOI: 10.1017/S146114570400481X

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.