Public HealthAntidepressant Ineffective Against Autism Spectrum Disorder Children's Obsessive Behavior
A new multi-center study, conducted at The Feinstein Institute for Medical Research in collaboration with five other centers throughout the country, tested the commonly prescribed antidepressant citalopram and found that it was no more effective than placebo in altering obsessive features of the condition - the spinning, rocking and repetitive behavior.
Like everything in medicine, the use of antidepressants in children with autism spectrum disorder took off before there was strong scientific proof about its effectiveness. In the last decade, its use has grown so that today more than 40 percent of autistic children swallow a daily dose of an antidepressant.
This study, published in the June 2009 issue of Archives of General Psychiatry, should serve to reduce the number of antidepressant prescriptions written for children with autism and similar conditions on the autism spectrum.
"Parents of children with autism spectrum disorders face an enormous number of treatment options, not all of which are research based," said Thomas R. Insel, MD, Director of the National Institute of Mental Health (NIMH). "Studies like this help us to better understand which treatments are likely to be beneficial and safe." The study was funded by the NIMH and other NIH institutes.
The Feinstein Institute"s Joel D. Bregman, MD, an expert on autism and one of the study investigators, said that the initial use of antidepressants grew out of a belief that some of the repetitive behaviors are similar to those seen among people with obsessive compulsive disorder. "We can"t rely on apparent similarities to other conditions and clinical experiences to guide our treatment strategies." Dr. Bregman said. "This was a large double-blind clinical trial that showed that this class of medicine is not effective in reducing these behaviors. These types of studies are essential."
The study followed 149 children between the ages of five and 17. About half were given a placebo dose and the others received the antidepressant. They were tested repeatedly over the 12-week study period. A positive response was defined by improvement on a number of behavioral measurements. "There was no significant difference in the rate of positive response" on these tests, the scientists concluded. "Results of the trial do not support the use of citalopram for the treatment of repetitive behavior in children and adolescents with autism spectrum disorder."
Citalopram is in a class of antidepressant medicines called selective serotonin reuptake inhibitors (SSRIs).
Initial smaller studies reported that SSRIs did make a difference. There is some biologic evidence to suggest that it would. Scientists have reported abnormalities in the brain regions that make the chemical serotonin. And people with obsessive compulsive disorder (OCD) also have serotonin abnormalities and often respond to the medication that helps the serotonin cells to function more normally. SSRIs are the most frequently prescribed medications for children with autism, Asperger disorder, or pervasive developmental disorder-not otherwise specified (PDD-NOS) spectrum disorder.
Part of the explanation for the mixed study results is that the placebo response is very high. In the latest study, one in three children in both groups - 32.9 percent of those treated with citalopram and 34.2 percent of those treated with placebo - were reported to have fewer or less severe symptoms.
The authors on the paper included: Bryan H. King, MD, Seattle Children"s Hospital; Eric Hollander, MD, Mount Sinai School of Medicine; Linmarie Sikich, MD, University of North Carolina, Chapel Hill; James T. McCracken, MD, University of California Los Angeles; Lawrence Scahill, MSN., PhD, Yale University; Dr. Bregman, MD, of the Feinstein Institute and North Shore Long Island Jewish Health System; Craig L. Donnelly, MD, Dartmouth Medical School; Evdokia Anagnostou, MD, Mount Sinai School of Medicine (currently at the University of Toronto); Kimberly Dukes, PhD, DM-STAT; Lisa Sullivan, PhD, Boston University; Deborah Hirtz, MD, National Institute of Neurological Disorders and Stroke (NINDS); Ann Wagner, PhD, NIMH; Louise Ritz, MBA, NIMH (currently at NINDS); and the STAART Psychopharmacology Network, a novel federal initiative.
Jamie Talan
North Shore-Long Island Jewish (LIJ) Health System