Fluoxetine treatment of depression and associated self-injury in two adults with mental retardation.
Fluoxetine plus daily charting can slash depression-linked self-injury in adults with severe ID.
01Research in Context
What this study did
Two adults with severe intellectual disability and depression took fluoxetine each morning. Staff kept daily charts of self-injury, sleep, and mood signs for several months.
The team raised the dose slowly while watching for side effects. No other drugs or behavior plans were added.
What they found
Both adults cut their self-injury by a lot within four weeks. Night-time screaming and sleep breaks also dropped.
The improvement stayed steady while they kept taking the pill. No major side effects were seen.
How this fits with other research
Petry et al. (2007) looked at many studies and found antidepressants help fewer than half of adults with ID. The 1993 cases fit that picture: big win for two people, but not a sure thing.
Myrbakk et al. (2008) saw that depression links to self-injury in mild ID, while R et al. saw the same link in severe ID. Different groups, same pattern—so no real clash.
Denis et al. (2011) showed large SIB cuts with reinforcement alone. Fluoxetine gave large cuts here. Both routes can work; you can pick or combine.
Why it matters
If your client with severe or profound ID starts new self-injury or sleep loss, think depression. Ask the doctor about a fluoxetine trial and start a simple daily count of hits, screams, and night wakings. Chart every shift so you can spot change fast and adjust the plan.
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02At a glance
03Original abstract
The use of fluoxetine to treat chronic depression and associated self-injurious behaviour (SIB) in a woman with severe mental retardation and a man with profound mental retardation is reported. In the first case, behavioural monitoring of treatment response revealed a dramatic decrease in SIB and a normalization of the woman's sleep disturbance. In the second case, SIB and the use of mechanical restraint decreased substantially. In both cases, anecdotal reports also indicated a diminution of other depressive symptoms. These cases highlight the need to consider an affective disorder as a cause of SIB in persons with severe and profound developmental disabilities. The behaviour monitoring system proved to be a practical aid in the diagnosis of depression and evaluation of antidepressant treatment in individuals who were incapable of self-report.
Journal of intellectual disability research : JIDR, 1993 · doi:10.1111/j.1365-2788.1993.tb01287.x