The effectiveness of antidepressant medication in the management of behaviour problems in adults with intellectual disabilities: a systematic review.
Antidepressants only modestly help aggression or SIB in adults with ID—check for anxiety or OCD first to avoid fruitless trials.
01Research in Context
What this study did
The team looked at every paper they could find on antidepressants for adults with intellectual disability. They wanted to know if these drugs calm aggression or self-injury.
Only studies that used pills like fluoxetine or clomipramine and counted behavior changes were kept. In the end they had a small pile of mostly short trials.
What they found
Fewer than half of the adults got any better. When improvement did happen, it was small.
The odds went up if the person also had clear signs of anxiety or OCD. Without those signs, the pills rarely helped.
How this fits with other research
LeFrancois et al. (1993) once showed two adults whose self-injury almost vanished on fluoxetine. The new review says such big wins are rare. The early cases were outliers, not the norm.
Reiss et al. (1993) found that aggressive clients are four times more likely to be depressed. The review builds on that link: antidepressants may work only when this hidden depression (or anxiety) is present.
Denis et al. (2011) showed that non-aversive reinforcement can also slash self-injury. The review adds a pill option, but both papers agree: first check what is driving the behavior, then pick the tool.
Why it matters
Before you refer an adult with ID for medication, screen for anxiety, OCD, or mood signs. If those are absent, the drug trail may waste time. If they are present, pills might help, but keep behavior data so you can spot small gains and taper if nothing changes.
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02At a glance
03Original abstract
BACKGROUND: A comprehensive systematic review was performed to establish the current evidence base regarding the effectiveness of antidepressant medication for the management of behaviour problems in adults with intellectual disabilities. METHOD: An electronic search of PsycInfo, Embase, Medline and Cinahl databases was conducted spanning the time period 1990 to October 2005 for primary trials. This was supplemented by hand searching and cross-referencing of relevant reviews. Strict scientific methodology requirements were formulated that the studies had to meet in order to merit inclusion in this review. RESULTS: One crossover randomized controlled trial in a small cohort, seven prospective uncontrolled trials and two retrospective studies were yielded in the search. Of these, one explored the effectiveness of the tricyclic antidepressant--clomipramine, and nine considered various selective serotonin reuptake inhibitors (SSRIs). CONCLUSION: Evidence based primarily on a small number of either prospective or retrospective case studies that included a small number of participants and often used non-validated outcome measures for a short period of follow-up, suggests that antidepressants, particularly SSRIs, show improvement of aggression and self-injurious behaviour on average in less than 50% of cases and the rest show either no improvement or deterioration. The effect is most pronounced in the presence of an underlying anxiety or an associated diagnosis of obsessive-compulsive disorder. Most studies have highlighted the concern regarding adverse effects.
Journal of intellectual disability research : JIDR, 2007 · doi:10.1111/j.1365-2788.2006.00935.x