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Adult Intermittent Explosive Disorder
Adult Intermittent Explosive Disorder
Diagnosis
Medication
Recommendation
Is a comorbid disorder present?
Yes
No
X
Inadequate
response
Adequate response
≥
50% reduction in symptoms
Intermittent Explosive Disorder
Evaluate and treat comorbidities;
see appropriate decision support
Recommend avoidance of alcohol
and other substances
Combination CBT (if available)
and pharmacotherapy
Fluoxetine (most studied);
other SSRIs may be reasonable
Follow up and titrate dose
as appropriate q 1-2 weeks.
Continue max tolerable dose
for 8-12 weeks
Max dose achieved
with inadequate
response (<50%
improvement)
Max dose NOT
achieved due to
side effects
Change to different SSRI;
Use fluoxetine if not previously trialed
Consider Psychiatry Referral
Limited literature available regarding
further best practices.
Some experts may consider trialing the
following medications:
Phenytoin
Oxcarbazepine/Carbamazepine
Lamotrigine
Topiramate
Valproate
Lithium
Maximally treat primary disorder prior
To treating IED
Maintenance
Continue at same dose
≥
2 years
then consider slow taper