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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 17541
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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My son is 23 and severely autistic, non verbal and generally

Customer Question

My son is 23 and severely autistic, non verbal and generally in good health and is in an autism specific residential care facility. He responds well to staff interaction and uses PECS for communication. However over the last two months he lost a member of staff who he was close to and has displayed extreme violence , aggression, and self harming , these episodes can go on for 4 to 5 hours at a time. The psychiatrist , who has not seen an extreme episode , was persuaded to provide some anxiety relief and prescribed 2mg diazepam 3 times per day , and a week of 25mg setraline to be increased to 50mg per day after that.This calmed him slightly for 5 days. After many more crisis situations she upped the dose to 5mg 3 times per day with 5mg PRN. His quality of life imprived dramatically for 2,5 weeks with laughter , ability to go on outings and great interaction. Now the diazepam is not working at all and he is becoming increasingly agitated, with almost constant self harming ( flapping to the extent of severe bruising on ribs and biting through knuckles on his hands and biting legs etc) He perspires and overheats dangerously and staff cannot get near him to administer water when required . The psychiatrist prescribed ibruprofen 400mg .... I have no idea what to next as this is an intolerable way for a young adult to live. He is 23 , 11 stone 5 and very fit and generally healthy
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. D. Love replied 1 year ago.
Hello from JustAnswer.
I am sorry that your son is having so many difficulties.
There is no single good answer for the medicine that will work in this situation.
The antidepressants, such as the sertraline, also can help ease anxiety and are commonly used for chronic relief of anxiety. However, it may be necessary to increase the dose, as 50 mg per day is still a relatively low dose. The antidepressants, though, take several weeks to build up in the system when started and with each dose change.
The benzodiazepines, such as diazepam, have the benefit of a more rapid relief of symptoms, but tolerance is common with these drugs. He has developed tolerance more quickly than average, but when tolerance develops, continuing to increase the dose will usually not solve the problem, as the person will usually develop tolerance to the higher dose.
Another option would be to use one of the newer medicines that are atypical antipsychotics, and which have also been shown to help with depression and anxiety. The two that have been most used to try to help with these problems with autism are risperidone and aripiprazole. These medicines have been recently studied for the relief of irritability, aggression, and self-injury, and have been shown to be effective for many patients. These medicines have a higher risk of side effects, so many doctors would rather try other options first. The most common significant side effects with long term treatment is weight gain, headache, and insomnia, but less common side effects are potentially more serious, including movement disorders or tardive dyskinesia.
So, most doctors would try to adjust the dose of sertraline first, but the use of risperidone or aripiprazole can be considered if symptoms persist.
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