LITHIUM AUGMENTATION OF FLUVOXAMINE IN AUTISTIC DISORDER - A CASE-REPORT

Preclinical and clinical evidence suggests that serotonin may be invol ved in the pathophysiology of autistic disorder. Drugs which facilitat e serotonin function have demonstrated relative efficacy in improving social relatedness, diminishing aggressivity, and reducing repetitive thoughts and behaviors in some patients with autism. This single-case report reviews the rationale for the use of lithium augmentation of a serotonin uptake inhibitor, fluvoxamine, in the treatment of autism. A 27-year-old man with autistic disorder was treated with fluvoxamine 2 00 mg (3 mg/kg) daily for 12 weeks and showed minimal clinical respons e. When lithium 900 mg daily (0.7 meq/L) was added to the fluvoxamine, a substantial clinical improvement in social relatedness and a marked reduction in aggressive and impulsive behavior were observed after tw o weeks. At the end of four weeks of treatment with fluvoxamine and li thium, the patient was rated as much improved on the several rating sc ales. He maintained this clinically meaningful improvement at 12-month follow-up, with no significant adverse effects. Controlled studies of lithium augmentation of treatment with serotonin uptake inhibitors ar e needed to determine whether this approach might benefit other patien ts with autistic disorder.