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Objective: Behavioral disinhibition is more commonly seen than (hypo)manic reaction during treatment with Selective Serotonin Reuptake Inhibitors (SSRIs). It is differentiated from (hypo)manic reaction by the absence of more specific manic symptoms such as elevated mood and grandiosity. Symptoms reported to be associated with drug induced behavioral disinhibition (DIBD) include increased oppositional behaviors, hyperactivity, excessive talking, irritability, socially inappropriate behavior(swearing, and obscene gesture), verbal and/or physical aggression, increased euphoria, akathisia or agitation, and self injurious behavior. We aimed to examine ten children, who developed behavioral disinhibition after the initiation of SSRI treatment.
Method: In this 10-case series, drug induced disinhibition was examined. Several sociodemographic and clinical parameters such as, distribution of disinhibition symptoms, DSM-IV diagnoses that necessitate antidepressant treatment, the comorbid conditions, and the time of emergence of symptoms, were evaluated.
Results: The age range of the children was 6-11 years (mean age 8.1±1.4 years). Of the children, 6 were male. The behavioral disinhibition symptoms were aggression, impulsivity, socially inappropriate behavior, hyperactivity, and excessive talking. In all cases, the symptoms diminished with the SSRI discontinuation. The most common diagnoses that require antidepressant treatment were obsessive compulsive disorder (n=4), depression (n=2), selective mutism (n=2) separation anxiety disorder (n=1), generalized anxiety disorder (n=1). In 7 of the cases, 4 of which are Attention Deficit Hyperactivity Disorder, a comorbid psychiatric diagnosis was present. The most common SSRI was şuoxetine (n=8/10) (10-30 mg/day). The remaining 2 were given sertraline (25 mg/day). The onset of disinhibition symptoms occurred within a range of 1 to 12 weeks, in half of the cases occurring within the first 4 weeks.
Conclusion: In our series, the onset of DIBD was observed typically 1 month after the SSRI exposure, similar to previous studies. We found that, şuoxetine, especially when used in the treatment of anxiety disorders and OCD, appeared to increase the risk of DIBD. As a result, the clinicians are advised to be more cautious, when using SSRIs in children for the treatment of anxiety disorders