Safety of pharmacotherapy with Selective Serotonin Reuptake Inhibitors in patients on the autism spectrum - Case report

Introduction: Depression is one of the most common mental disorders in the world, and treatment of this condition often includes the use of selective serotonin reuptake inhibitors (SSRI). Despite their widespread use and effectiveness, SSRI can cause adverse effects, especially in the pediatric and adolescent population, which requires close specialized supervision. A particularly vulnerable group are patients with autism spectrum disorders, where reactions to SSRI can be atypical and unpredictable. Purpose: The aim of this study is to report an atypical response to sertraline treatment in a minor patient with a diagnosis of Asperger's syndrome, resulting in impulsive and aggressive behavior with legal consequences. Case description: A 16-year-old patient with Asperger syndrome was treated with sertraline for depression and suicidal thoughts. Within three weeks of starting therapy, he developed severe symptoms of agitation, delusions and aggressive behavior that led to conflict with the law. The patient was referred for forensic psychiatric observation, where he was diagnosed with acute psychosis with symptoms of delusions of grandeur meeting the criteria for acute manic state F30.2. according to the ICD­10 classification. Conclusions: This case illustrates the risks of using SSRI in autistic patients, indicating the need for further studies on the safety of pharmacotherapy with this group of drugs in this population. The authors suggest special caution and the need to monitor children and adolescents taking SSRIs and to consider hospital conditions for the treatment of at-risk patients. Keywords: sertraline, SSRI, pharmacotherapy safety, ssri side effects