Effects of antidepressants on longevity and dementia onset among adults with Down syndrome: a retrospective study.

OBJECTIVE: To investigate the effects of antidepressants on longevity, age at dementia onset, and survival after onset among adults with Down syndrome, controlling for late-onset seizures, trisomy 21 mosaicism, and cholinesterase inhibitor use. METHOD: The charts of 357 adults with Down syndrome (mean age at first visit = 46.3 years, SD = 9.0) evaluated in a metropolitan diagnostic and research clinic between 1990 and 2008 were reviewed. Seventeen patients had trisomy 21 mosaicism; 155 patients were diagnosed with depressive disorders using DSM-III-R and IV criteria, 78 of whom received antidepressants for over 90 days. Of 160 patients who developed dementia, the estimated mean age at onset was 52.8 years. Fifty-six patients (demented and nondemented) had late-onset seizures. Longevity and age at estimated onset among those receiving and not receiving antidepressants were compared. Cox proportional hazards models examined risks for dementia onset and death. RESULTS: The mean age at dementia onset among those receiving antidepressants before onset was 53.75 years versus 52.44 years among others. Proportional hazards models showed a significant delay of onset among those taking antidepressants (hazard ratio = 0.69; 95% CI, 0.48-0.98; P = .038). Mean age at death or at end of study for those receiving antidepressants was 54.71 years; among others, it was 52.60 years (hazard ratio = 0.63; 95% CI, 0.42-0.94; P = .024). Among the 35 adults with late-onset seizures and dementia who died, mean survival after seizure onset was 4.23 years. CONCLUSIONS: The findings in this retrospective study revealed that antidepressant use was associated with delayed dementia onset and increased longevity in adults with Down syndrome; mean survival after late-onset seizures was longer than previously reported. Further studies, however, are needed to confirm these associations, optimally in a clinical trial to confirm causality.

Treatment of previously undiagnosed psychiatric disorders in persons with developmental disabilities decreased or eliminated self-injurious behavior.

BACKGROUND: Self-injurious behavior (SIB) is one of the most common challenging behaviors in persons with autistic disorder or severe/profound mental retardation. Many psychotropic drugs have been evaluated for their effectiveness in SIB. Results have varied, and no one psychotropic drug has been indicated for SIB. In this prospective, open clinical study, psychotropic drugs were used to treat the previously undiagnosed psychiatric disorder in persons exhibiting SIB. METHOD: Data were collected from 26 individuals with mental retardation (14 males, 12 females), 7 to 45 years of age (mean = 30.3 years), who exhibited SIB. Psychiatric diagnosis was made according to DSM-III-R and DSM-IV criteria. The Behavior Problem Inventory, Yudofsky's Overt Aggression Scale, repeated direct observation, and information on use of protective devices and Likert scales from log books were used to evaluate degree of SIB. Most of the patients were treated with different psychotropic drugs and behavior modification before they were evaluated for this study, but only 7 of them carried a psychiatric diagnosis. Data were collected between 1987 and 1997. RESULTS: Depressive disorders, impulse-control disorder, and anxiety disorder were the most common final diagnoses. Neuroleptics were discontinued in 5 patients and tapered by 50% to 75% in 14 patients. Antidepressants were added in 12 patients. Treatment of psychiatric disorders produced significant (p < .001) decrease in the severity of SIB in the 26 patients, and SIB was eliminated in 12 patients. The severity of SIB decreased to mild from a moderate, severe, or extreme degree in 11 patients and from an extreme to a severe degree in 3 patients. CONCLUSION: The most effective treatment for SIB that is resistant to environment changes and behavior modification in persons with developmental disabilities is the treatment of their psychiatric disorders with the appropriate psychotropics.