The use of antidepressant medication to improve symptoms in autistic children may not be effective.
According to a new statistical review of previously reported studies, the use of selective serotonin reuptake inhibitor (SSRIs) antidepressants did not improve overall function.
"There is no evidence of effect of SSRIs in children and emerging evidence of harm. There is limited evidence of the effectiveness of SSRIs in adults from small studies in which risk of bias is unclear," according to Katrina Williams of the School of Women’s and Children’s Health at the University of New South Wales in Australia and her team.
Autism is the most severe syndrome on a range of autism spectrum disorders (ASDs). The numbers of individuals affected appear to be growing, according to the Centers for Disease Control and Prevention (CDC). One out of every 110 eight-year-olds are affected. Four times more common in boys, girls often have more severe symptoms, according to the National Institute of Mental Health. A variety of treatments have been promoted to treat or ‘cure’ autism. Scientific research has shown several forms of therapy to be effective in improving function. However, no cure currently exists, and parents and clinicians struggle to find effective pharmacological options.
According to Williams, "Autism spectrum disorders (ASD) are characterised by abnormalities in social interaction and communication skills, as well as stereotypic behaviours and restricted activities and interests. Selective serotonin reuptake inhibitors (SSRIs) are prescribed for the treatment of co-morbidity associated with ASD such as depression, anxiety and obsessive-compulsive behaviors."
To assess whether SSRI therapy "1. improves the core features of autism (social interaction, communication and behavioral problems); 2. improves other non-core aspects of behavior or function such as self-injurious behavior; 3. improves the quality of life of children and their carers; 4. has short- and long-term effects on outcome; 5. causes harm," the team combined the data gathered by researchers in previously published studies.
Williams and her team searched six large databases that contained previously published medical studies and found seven randomized controlled study research papers that had investigated the treatment of autism spectrum disorders with SSRIs. The medications studied included fluoxetine (Prozac), fluvoxamine (Luvox), fenfluramine and citalopram (Celexa).
Seven randomized controlled trials were included in the study, five with children, and two with adults. Each study had different design characteristics, including specific medications tested, study subjects, or outcomes measured. Statistical analysis to compensate for these differences was done when possible.
The team found that although the designs of the studies made combining the data statistically inappropriate, there was currently no good evidence showing overall improvement in treating children with autism, and "one large, high-quality study in children showed no evidence of positive effect of citalopram."
In one study, a child who had taken citalopram suffered a prolonged seizure.
However, per the team, "two small studies in adults showed positive outcomes for Clinical Global Impression and Obsessive Compulsive Behavior; one study showed improvements in aggression and another in anxiety."
"Not all the SSRIs currently in use have undergone controlled trials for autistic spectrum disorders, but parents are often anxious to try treatments regardless of the lack of evidence. It’s important that doctors are open about the lack of evidence, and explain any risks fully, before prescribing these treatments."
This study is important in giving clinicians and parents additional guidance into which therapies and medications may be of use in treating autistic symptoms. Just as important as finding successful therapies, data on unhelpful therapies are beneficial. While a number of medications are prescribed for autism, many are not FDA-approved. SSRIs are among the most frequently prescribed medications, although none have been specifically approved for use in autism. However, mental health issues, if they occur along with autism, might warrant treatment with medication, including antidepressants.
"We can't recommend SSRIs as treatments for children, or adults, with autism at this time. However, decisions about the use of SSRIs for co-occurring obsessive-compulsive disorder, aggression, anxiety or depression in individuals with autism should be made on a case by case basis."
Williams results can be seen in the August 4th Cochrane Database Systemic Review.