Abstract
Aims and methodTo study the use of antidepressants in adults with intellectual disability, focusing on medication type, indication, retention and clinical outcome. Case notes of all service users in a learning disability service were hand-searched to identify antidepressant usage, and those who had been treated with antidepressants and in whom at least 1 year of follow-up was possible were included in the study.ResultsA total of 241 treatment episodes were identified. The rates of positive outcome in terms of clinical improvement at 6 weeks, 6 months and 12 months were 49.4%, 48.1% and 49% respectively, and only 29 (12%) episodes of side-effects had been noted.Clinical implicationsAntidepressants are commonly prescribed in adults with intellectual disability. Approximately half did well in terms of clinical improvement.
Highlights
Clinical implications Antidepressants are commonly prescribed in adults with intellectual disability
As regards the severity of intellectual disability, this was mild in 43% of the sample, moderate in 26.2%, severe in 16.3%, profound in 2.3% and borderline intellectual disability in 2.7%; in 9.5% of the sample, the level of intellectual disability was not classified
The underlying cause of intellectual disability was not known in 77% of the cases
Summary
The majority (88%) of child psychiatrists and 33% of paediatricians had prescribed atypical antipsychotics, most commonly risperidone. Challenging behaviour in developmental disorders was the most common indication for atypicals Both child psychiatrists and paediatricians prescribed atypicals for nonpsychotic developmental disorders, whereas prescribing for psychosis occurred almost exclusively among psychiatrists. The survey highlights the need for training and guidance on prescribing and monitoring of atypical antipsychotic use in children and adolescents. Reasons for changing prescribing practice are various and may include an increased evidence base of efficacy, concerns about the adverse effect profile of typical antipsychotics in young people, better training in paediatric psychopharmacology, greater drug availability and promotion, and possibly pressure on clinicians to act promptly and unavailability of non-pharmacological interventions.[1,2] In children there is evidence that most atypical antipsychotics are prescribed
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