Patients with abrupt early-onset OCD due to PANS tolerate lower doses of antidepressants and antipsychotics

SUMMARY

“Patients with abrupt early-onset OCD due to PANS tolerate lower doses of antidepressants and antipsychotics” examined pediatric patients diagnosed with Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) who, prior to their PANS diagnosis at the Stanford Immune Behavioral Health Clinic, were treated with multiple trials of antidepressants and antipsychotics based on standard pharmacotherapy dosing. Adverse effects, the most common being behavioral activation, were common. Side effects included irritability, agitation, anxiety, panic, depression, suicidality, restlessness, hostility, aggression, insomnia, disinhibition, emotional lability, impulsivity, social withdrawal, hypomania/mania, paranoia and other psychotic symptoms. Some children required hospitalization for suicidality, mood lability, agitation and behavioral dyscontrol.

The findings indicate an unusual drug sensitivity to antidepressants and antipsychotics in the PANS population, likely related to underlying neuroinflammation affecting the basal ganglia. As a result, clinicians are advised to initiate psychotropic medications at significantly lower doses than those typically used for other pediatric psychiatric conditions. This study reinforces the previously advised recommendation to “start low and go slow” when using antidepressants and antipsychotics as part of the three pronged PANS treatment approach that addresses the source (infections), the immune system dysfunction, and the symptoms.

LINK TO PAPER: https://doi.org/10.1016/j.jpsychires.2021.01.022