Psychopharmacology of mood disorders in persons with mental retardation and autism

Abstract

The ever-growing range of designer drugs such as selective serotonin reuptake inhibitors (SSRIs) and other new antidepressants, atypical antipsychotic agents, and antiseizure medications may improve treatment efficacy and safety for persons with mood disorders and mental retardation (MR) and autism. Mood disorders are still frequently undiagnosed or misdiagnosed, and are often chronic and atypical. Diagnosis must rely on reporting of signs of the illnesses by caregivers, rather than by self-report. A key issue guiding the use of mood stabilizers as first-line drugs instead of antidepressants is the present or past existence of manic features. Chronic and atypical forms of bipolar disorder often require multiple mood stabilizers for acute and maintenance treatment. The role of the atypical antipsychotic agents in acute and maintenance treatment of mood disorders requires further study in this population, in terms of lower long-term risk and possible beneficial cognitive effects. The SSRIs appear to be broad spectrum and offer ease of prescription, may reverse some of the core features of autism, and can be beneficial for self-injury, explosive outbursts, and depressive and anxiety symptoms and behaviors. However, in view of the risk of drug interactions, together with the often numerous physicians treating mentally retarded persons for epilepsy and psychiatric and physical illness, scrupulous attention to pharmacotherapy detail and vigilance for drug interactions is essential. Research studies are needed to better characterize the phenomenology, biology, and treatment responses in the MR population. MRDD Research Reviews 1999;5:270–278. © 1999 Wiley-Liss, Inc.