A Case of Prepubertal Low-Functioning Autism With Behavioral Decompensation Favorably Responding to Tianeptine.

TLDR: A case of essential ASD and moderate intellectual disability with a severe behavioral component that failed multiple psychotropic trials either for ineffectiveness or poor tolerability issues is reported, which has ultimately responded favorably to the atypical antidepressant, tianeptine at 25 mg/d with great tolerability.

Abstract: Copyright © maladaptive challenging behaviors. Pharmacotherapy is indicated once psychosocial and educational interventions (eg, Lovaas' applied behavior analysis) prove ineffective, inadequate, or inaccessible. A sound evidence-base supports the use of atypical antipsychotics to address these behavioral facets. This is reflected in Food and Drug Administration approval of both risperidone (5–16 years) and aripiprazole (6–17 years) to tackle severe irritability (self-injury, tantrums, and aggression). Unfortunately, these agents are plaguedwith heinous neurohormonal and cardiometabolic (diabesity) adverse effects, in this population who are at a heightened vulnerability by virtue of neurodisability and young age. These problem behaviors could interfere with acquisition of more functional and adaptive behaviors, add to caregivers' distress, and are a primary reason for referral to a child psychiatrist. These include, inter alia, attention-deficit/hyperactivity disorder symptom profile, severe irritability, aberrant sleeping and eating patterns, inappropriate sexuality, and comorbid anxiety, mood disorders, catatonia, or tics. There is then a pressing need to explore agents that are both efficacious and tolerable. Here, we report a case of essential ASD and moderate intellectual disability with a severe behavioral component that failed multiple psychotropic trials either for ineffectiveness or poor tolerability issues. Interestingly, the case has ultimately responded favorably to the atypical antidepressant, tianeptine at 25 mg/d with great tolerability. Response was well sustained over a 30-week duration at the time of writing up this report. Tianeptine is uniquely a selective serotonin reuptake enhancer antidepressant. It additionally enhances extracellular dopamine in nucleus accumbens and is a μ opiate agonist, hence possessing an abuse potential. It has also been demonstrated to normalize stress-induced glutamate excitotoxicity in