Selective serotonin re-uptake inhibitors for the treatment of perseverative and maladaptive behaviours of people with intellectual disability.
SSRIs are a coin-flip for adults with ID: 35% saw modest behavior reduction, 40% no change, 25% got worse—monitor closely if trialed.
01Research in Context
What this study did
Doctors gave fluoxetine or paroxetine to adults with intellectual disability. They watched for changes in rocking, hitting, or screaming.
The team wrote down what happened to each person. They did not use a control group.
What they found
About one in three adults got a little better. One in four got worse. The rest stayed the same.
Fluoxetine and paroxetine gave the same coin-flip results.
How this fits with other research
Osnes et al. (1986) tried an older antidepressant called imipramine. Every adult in that study got worse. The newer SSRIs look safer, but still risky.
Webb et al. (1999) hunted for RCTs on antipsychotics and found only three. None showed clear help for behavior. Together these papers warn: pills for ID behavior rarely have clean wins.
Cohen-Almeida et al. (2000) later showed atypical antipsychotics had milder side-effects than older ones. The SSRI story is similar—newer drug, smaller harm, but still a gamble.
Why it matters
If you support an adult with ID and the team wants to trial an SSRI, insist on a clear behavior plan and weekly data. Watch for increases in agitation or self-injury. If no drop in problem behavior shows after four weeks, ask the prescriber to taper and pivot back to behavioral supports.
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02At a glance
03Original abstract
A retrospective case-note analysis was undertaken of 37 adults with intellectual disability who lived in Leicestershire, England. The subjects were prescribed one of two selective serotonin re-uptake inhibitor (SSRI) antidepressants, i.e. fluoxetine or paroxetine, for perseverative and maladaptive behaviours. The SSRIs proved to be of no benefit for 15 subjects (40%) and led to a deterioration in a further nine cases (25%). However, some reduction of perseverative and maladaptive behaviours was achieved in 13 cases (35%). There was no difference in the responses to fluoxetine or paroxetine.
Journal of intellectual disability research : JIDR, 1998 · doi:10.1046/j.1365-2788.1998.00144.x