Cyclical suicidal ideation following natalizumab infusion for multiple sclerosis.

Australian & New Zealand Journal of Psychiatry, 49(7) with anti-migraine and anti-epileptic medications. Risperidone, olanzapine and clonidine were used without sustained benefit. A trial of escitalopram was initiated following parental request, based on their own investigation on a Rett syndrome Internet forum. An immediate benefit was noted which lasted for 3 months. Head-banging episodes reduced significantly in frequency and duration. She was sleeping for 11 hours each night. Unfortunately, she developed SSRI-induced bruxism. As the escitalopram dose was reduced, bruxism reduced but behavioural issues and sleep disturbances increased. To our knowledge this is the first case report demonstrating the success of escitalopram in managing behavioural problems associated with Rett syndrome. SSRIs may assist through different mechanisms. Fluoxetine increases MeCP2 expression in rat brains (Chapleau et al., 2013; Pan and Tsai, 2012). SSRIs have been shown to enhance BDNF expression (Chapleau et al., 2013; Pan and Tsai, 2012). Patients with Rett syndrome and mice null for MeCP2 show reduced levels of brain serotonin, thus by adjusting serotonin levels, SSRIs might improve mood and behavioural disturbance (Chapleau et al., 2013; Percy, 2014). Larger animal and human trials are needed to empirically validate the effectiveness of SSRIs in moderating behavioural and sleep disturbance in Rett syndrome.