Psychopharmacology of mood disorders in persons with mental retardation and autism

The ever-growing range of designer drugs such as selective serotonin reupta ke inhibitors (SSRIs) and other new antidepressants, atypical antipsychotic agents, and antiseizure medications may improve treatment efficacy and saf ety for persons with mood disorders and mental retardation (MR) and autism. Mood disorders are still frequently undiagnosed or misdiagnosed, and are o ften chronic and atypical. Diagnosis must rely on reporting of signs of the illnesses by caregivers, rather than by self-report. A key issue guiding t he use of mood stabilizers as first-line drugs instead of antidepressants i s the present or past existence of manic features. Chronic and atypical for ms of bipolar disorder often require multiple mood stabilizers for acute an d maintenance treatment. The role of the atypical antipsychotic agents in a cute and maintenance treatment of mood disorders requires further study in this population, in terms of lower long-term risk and possible beneficial c ognitive effects. The SSRIs appear to be broad spectrum and offer ease of p rescription, may reverse some of the core features of autism, and can be be neficial for self-injury, explosive outbursts, and depressive and anxiety s ymptoms and behaviors. However, in view of the risk of drug interactions, t ogether with the often numerous physicians treating mentally retarded perso ns 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, biol ogy, and treatment responses in the MR population. (C) 1999 Wiley-Liss, Inc .