The Breakthrough: (Abstract) Adult patients with Down syndrome show psychological symptoms and early senility. Improving their environment and dealing with their complaints and stress should first address their behavioral problems, such as self-injury, depression, aggression and outbursts. Pharmacological treatment may also be tried for behavioral disorders. Individuals with Down syndrome demonstrate neurotransmitter changes such as the loss of acetylcholine, norepinephrine, and serotonin (5-HT) with increasing age. Selective serotonin re-uptake inhibitor (SSRI) is effective for depression and panic disorders. We report here the effect of SSRI in two adult male patients with Down syndrome, 35 and 47 years of age. Self-injury in one case and aggression and outbursts in another improved after 1 week of fluvoxamine treatment, suggesting the effects of SSRI for behavioral disorders of adult Down syndrome.

- 2004 Sep;36(5):391-4.
[Two cases of adult Down syndrome treated with selective serotonin re-uptake inhibitor for behavior disorders]
[Article in Japanese]
Hirayama T, Kobayashi T, Fujita T, Fujino O.
Department of Pediatrics, National Hospital Organization Fukushima Hospital, Sukagawa, Fukushima.

OBJECTIVE: (Abstract) This paper reports a case of obsessive-compulsive disorder (OCD), major depression, and anorexia nervosa in a Down’s syndrome patient.
RESULTS: Mental retardation and OCD narrowed the patient’s available means to control over life. First he became depressed. Perhaps because of insufficient treatment of the depression or in the context of controlling his body and inner life, anorexia nervosa developed.
DISCUSSION: His clinical presentation, diagnostics, and successful treatment of psychiatric disorders and anorexia nervosa are presented.

- PMID: 15461027 [PubMed - indexed for MEDLINE]
Int J Eat Disord. 1998 Jan;23(1):107-9.
Anorexia nervosa, major depression, and obsessive-compulsive disorder in a Down’s syndrome patient.
Raitasuo S, Virtanen H, Raitasuo J.
Special Welfare District of Southwest, Finland.

(Abstract): Alzheimer’s disease (AD) is a common cause of functional decline in Down syndrome (DS) adults. Acquired cognitive deficits may be difficult to evaluate in the context of baseline impairments. Behavioral symptoms are also common and may represent the effects of depression, AD, or both. Therefore, the objective of this study was to report a clinical case series of selected adults with DS and behavioral change who responded to treatment with selective serotonin-reuptake inhibitor (SSRI) medication.

Six patients, aged 23 to 63 years, 5 women and 1 man, with the clinical diagnosis of DS presented for diagnosis and treatment of functional decline in adult life. Noncognitive symptoms were prominent and included aggression, social withdrawal, and compulsive behaviors. Memory dysfunction was reported in varying degrees. Treatment with SSRI antidepressants was instituted for depressive, apathetic, and compulsive behaviors. Treated patients showed improvement in behaviors as reported by caregivers, and on objective measures, such as workplace productivity. Noncognitive symptoms are a cardinal feature of functional decline in adults with DS and may represent either depression or AD. In some patients, the symptoms respond well to SSRI agents with concomitant improvement in daily function. Treatment trials with SSRIs may, therefore, be warranted in such cases.

- J Geriatr Psychiatry Neurol. 1997 Jul;10(3):99-104.
Treatment of functional decline in adults with Down syndrome using selective serotonin-reuptake inhibitor drugs.
Geldmacher DS, Lerner AJ, Voci JM, Noelker EA, Somple LC, Whitehouse PJ.
Alzheimer Center, University Hospitals of Cleveland, USA.

PMID: 9322131 [PubMed - indexed for MEDLINE]

Excessive synthesis of prostaglandin E2 causes Down’s, antidepressants block prostaglandin E2. Trisomy X of Down’s is dormant unless activated by excessive prostaglandin E2 production.