Abstract
Depression in mentally retarded individuals is not uncommon and usually is treatable. However, studies of the diagnosis and treatment of psychiatric illnesses in general and depression specifically in this population are relatively rare. Although Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria can be applied to mildly and moderately retarded individuals, the diagnosis of depression in those with intelligence quotients below 35 is challenging. However, the diagnosis of depression in the latter group is possible using modified criteria emphasizing observational data. Criteria include symptoms such as sadness, irritability, decreased social interaction, regression of skills, sleep disturbances, diurnal variation, and aggression. Furthermore, there is a growing body of evidence that antidepressant treatments, especially administration of selective serotonin reuptake inhibitors, are effective in treating depression in mentally retarded patients. This article reviews numerous studies elaborating on the diagnosis, phenomenology, and treatment of depression in mentally retarded individuals.
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References and Recommended Reading
Ailey SH, Miller A: Psychosocial theories of depression for individuals with intellectual and developmental disabilities; a historicist perspective. Res Theory Nurs Pract 2004, 18:131–148.
Marston GM, Pery DW, Roy A: Manifestations of depression in people with intellectual disability. J Intellect Disabil Res 1997, 41:476–480.
Linaker OM, Nitter R: Psychopathology in institutionalized mentally retarded adults. Br J Psychiatry 1990, 156:522–525.
Sovner R, Hurley AD: Do the mentally retarded suffer from affective illness? Arch Gen Psychiatry 1983, 40:61–67.
Reiss S: Handbook of Challenging Behavior: Mental Health Aspects of Mental Retardation. Worthington, OH: IDS Publishing Corporation; 1994.
Heiman T: Depressive mood in students with mild intellectual disability: students’ reports and teachers’ evaluations. J Intellect Disabil Res 2001, 4:526–534.
Jackowska E, Deg-Rudewicz K: Depressive Disorders in adolescents with mild retardation. Psychiatr Pol 2004, 37–49.
Russell AT, Tanquay PE: Mental retardation: cause or coincidence. Amer J Ment Defic 1981, 146:242–245.
Rinck C: Epidemiology and psychoactive medication. In Psychotropic Medications and Developmental Disabilities: The International Consensus Handbook. Edited by Reiss S, Aman MG. Columbus, OH: Ohio State University Nisonger Center; 1998:31–44.
Smiley E, Cooper SA: Intellectual disabilities, depressive episode, diagnostic criteria and Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/ Mental Retardation (DC-LD). J Intellect Disabil Res 2003, 47:62–71.
Schloss P, Epstein MH, Cullinan D: Depression characteristics among mildly handicapped students. Multihandicapped Pers 1988, 1:293–302.
Sovner R: Limiting factors in the use of DSM III criteria with mentally ill/mentally retarded persons. Psychopharm Bul 1986, 22:1055–1059.
Davis JP, Judd FK, Herrman H: Depression in adults with intellectual disability. Part 2; a pilot study. Aust N Z J Psychiatry 1997, 31:243–221.
Sovner R, Fogelman S: Irritability and mental retardation. Semin Clin Neuropsychiatry 1996, 1:105–114.
Meins W: A new depression scale designed for use with adults with mental retardation. J Intellect Disabil Res 1996, 40:222–226.
Meins W: Symptoms of major depression in mentally retarded adults. J Intellect Dis Res 1995, 39:41–45.
Esbensen AJ, Rojahn J, Aman MG, Ruedrich S: Reliability and validity of an assessment instrument for anxiety, depression, and mood among individuals with mental retardation. J Autism Dev Disord 2003, 33:617–629.
Ross E, Oliver C: The assessment of mood in adults who have severe or profound mental retardation. Clin Psychol Rev 2003, 23:225–245. This is a good review of issues regarding depression in the severely and/or profoundly retarded.
Clarke DJ, Cumella S, Corbett J, et al.: Use of ICD-10 Research diagnostic criteria to categorise psychiatric and behavioural abnormalities among people with learning disabilities: the West Midlands field trial. Ment Handicap Res 1994, 7:273–285.
Clarke DJ, Gomez GA: Utility of Modified DCR-10 criteria in the diagnosis of depression associated with intellectual disability. J Intellect Disabil Res 1999, 43:413–420. This article offers a number of plausible modifications of standardized diagnostic criteria, as applied to the mentally retarded.
Hucker SJ, Day KA, George S, Roth M: Psychosis in mentally handicapped adults. In Psychiatric Illness and Mental Handicap. Edited by James FE, Snaith RP. London: Gaskell; 1979:28.
Cooper SA, Collacott RA: Depressive episodes in adults with learning disability. Irish J Psycol Med 1996, 13:105–113.
Szymanski LS, King B, Goldberg B, et al.: Diagnosis of mental disorders in people with mental retardation. In Psychotropic Medications and Developmental Disabilities: The International Consensus Handbook. Edited by Reiss S, Aman MG. Columbus, OH: Ohio State University Nisonger Center; 1998:3–17. This author offers modified criterion for depression in the mentally retarded. The book, although somewhat outdated, is extremely comprehensive regarding the psychopharmacology of mental retardation.
Harper DC, Wadsworth JS: Grief in adults with mental retardation: preliminary findings. Res Dev Disabil 1993, 14:313–330.
Walters RM: Suicidal behavior in severely mentally handicapped patients. B J Psychiatry 1990, 157:444–446.
Patja K, Livanainen M, Raitasuo S, Lonnqvist J: Suicide mortality in mental retardation: a 35-year follow-up study. Acta Psychiatr Scand 2001, 103:307–311. This article documents suicidality in the mentally retarded over a uniquely long period.
Lunsky Y: Suicidality in a clinical and community sample of adults with mental retardation. Res Dev Disabil 2004, 25:231–243.
Ghaziuddin M, Alessi N, Greden JF: Life events and depression in children with pervasive developmental disorder. J Autism Dev Disord 1995, 25:495–502.
Mattes JA, Amsell L: The dexamethazone suppression test as an indication of depression in patients with mental retardation. Am J Ment Retard 1993, 98:354–359.
Reiss S, Rojahn J: Joint occurrence of depression and aggression in children and adults with mental retardation. J Intellect Dis Res 1993, 37:287–294.
Holden B, Gitlesen JP: Prevalence of psychiatric symptoms in adults with mental retardation and challenging behaviour. Res Dev Disabil 2003, 24:323–332.
Ross E, Oliver C: The relationship between levels of mood, interest and pleasure and ‘challenging behaviour’ in adults with severe and profound intellectual disability. J Intellect Disabil Res 2002, 46:191–97.
Tsiouris JA, Mann R, Patti PJ, Sturmey P: Challenging behaviours should not be considered as depressive equivalents in individuals with intellectual disability. J Intellect Disabil Res 2003, 47:14–21.
Lund J: Treatment of psychiatric morbidity in the mentally retarded adult. Acta Psychiatr Scand 1986, 73:429–436.
Lindsay WR, Howells L, Pitcaithly D: Cognitive therapy for depression with individuals with intellectual disabilities. Br J Med Psychol 1993, 66:135–141.
Puri BK, Langa A, Coleman RM, Singh I: The clinical efficacy of maintenance electroconvulsive therapy in a patient with a mild handicap. Br J Psychiatry 1992, 161:707–709.
Kessler RJ: Electroconvulsive therapy for affective disorders in persons with mental retardation. Psychiatr Q 2004, 75:99–104.
Howland RH: Fluoxetine treatment of depression in mentally retarded adults. J Nerv Ment Dis 1992, 180:202–205.
Masi G, Maracheschi M, Pfanner P: Paroxetine in depressed adolescents with intellectual disability: an open label study. J Intellect Disabil Res 1997, 41:268–272.
Sovner R, Fox CJ, Lowry MJ, Lowry MA: Fluoxetine treatment of depression and associated self-injury in two adults with mental retardation. J Intellect Dis Res 1993, 37:301–311.
Hamdan-Allen G: Brief report: Trichotillomania in an autistic male. J Autism Dev Disord 1991, 21:79–82.
Cook Jr EH, Rowlett R, Jaselskis C, Leventhal BL: Fluoxetine treatment of children and adults with autistic disorder and mental retardation. J Am Acad Child Psychiatry 1992, 31:739–745.
Aman MG, White AJ, Vaithianathan C, Teehan DJ: Preliminary study of imipramine in profoundly retarded residents. J Autism Dev Disord 1986, 16:263–273.
Field CJ, Aman MG, White AJ, Vaithianathan C: A singlesubject study of imipramine in a mentally retarded woman with depressive symptoms. J Ment Defic Res 1986, 30:191–198.
Ruedrich SL, Wilkinson L: Atypical unipolar depression in mentally retarded patients; Amoxapine treatment. J Nerv Ment Dis 1992, 180:206–207.
Janowsky DS, Shetty M, Barnhill J, et al.: Serotonergic antidepressant effects on aggressive, self injurious and destructive/ disruptive behaviours in intellectually disabled adults: a retrospective, open-label, naturalistic trial. Int J Neupsychopharm 2005, 8:37–48. An up-to-date review of the use of SSRIs to treat challenging behaviors and depression in the mentally retarded.
Lowry MA, Sovner R: Severe behaviour problems associated with rapid cycling bipolar disorder in two adults with profound mental retardation. J Intellect Disabil Res 1992, 36:269–281.
Vanstraelen M, Tyrer SP: Rapid cycling bipolar affective disorder in people with intellectual disability: a systematic review. J Intellect Disabil Res 43 349–359.
Hasan MK, Mooney RP: Three cases of manic depressive illness in mentally retarded adults. Am J Psychiatry 1979, 136:1069–1071.
Reid RH: Psychoses in adult mental defectives: II. Schizophrenic and paranoid psychoses. Br J Psychiatry 1972, 12:213–218.
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Janowsky, D.S., Davis, J.M. Diagnosis and treatment of depression in patients with mental retardation. Curr Psychiatry Rep 7, 421–428 (2005). https://doi.org/10.1007/s11920-005-0062-z
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DOI: https://doi.org/10.1007/s11920-005-0062-z