Preliminary study of imipramine in profoundly retarded residents.

Researchers gave imipramine to adults with profound intellectual disability. They used a double-blind crossover design so no one knew who got the pill or the placebo.

Each adult got 3 mg of imipramine for every kilogram of body weight each day. The team watched for changes in mood, movement, and self-care skills.

The drug made things worse. Adults became more irritable, more withdrawn, and moved around too much.

Skills like feeding and dressing dropped. The study stopped early because the harm was clear.

Clarke et al. (1998) later tested SSRIs in the same group. About one in four adults also got worse on those newer antidepressants. Both papers warn that any antidepressant can backfire in people with severe ID.

Webb et al. (1999) hunted for RCT proof that antipsychotics help challenging behavior. They found almost none. Together with Osnes et al. (1986), the message is: pills for behavior in ID need rock-solid evidence before you try them.

Cohen-Almeida et al. (2000) showed atypical antipsychotics had milder side-effects than older ones. That finding does not clash with G et al.; it simply shifts the risk question to a different drug class.

If a psychiatrist suggests imipramine for your adult client with profound ID, show them this paper. The risk of sudden behavior collapse is real. Push for a functional assessment and evidence-based behavioral interventions first. When medication is on the table, ask for data from people who match your client’s profile, not just general psychiatry studies.