SSRI drug therapy may not be helpful for children with autism.
Many youths with autism do not respond well to SSRI (selective serotonin reuptake inhibitors) drug therapy (paroxetine, fluoxetine, sertraline, etc.). This study reports on the outcome of youths with autism who received a second round of SSRI therapy after treatment failure on a first SSRI. Only one third of children who received a second round of SSRI therapy had a good response to the second SSRI therapy. This response rate was low and was lower than has been shown in other studies. The authors also found that side effects were common on the SSRI therapy.
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Citalopram: No Effect in Autism
Dec 3, 2009 by AnonymousDoes citalopram help children with autism? A Citalopram (Cilexa®) study made a big splash in the autism community this month. Citalopram is an antidepressant that has been prescribed off-label for children with autism. Doctors thought it might reduce repetitive behaviors (rocking, hand flapping, etc.) in children with autism. A new study suggests that it probably won’t make a difference.
Citalopram is a selective serotonin reuptake inhibitor (SSRI) which is a class of drugs that are FDA-approved for depression. SSRIs are said to be widely prescribed off-label for children with autism, but hard numbers are not known because of the off-label use. They are prescribed off-label for other conditions, including obsessive compulsive disorder (OCD) in children.
King et al (2009) reported results of a large randomized, placebo-controlled, double-blind study of citalopram with 149 children (5-17 years old). The children had autism, Asperger syndrome, or pervasive developmental disorder not otherwise specified (PDD-NOS). All of the children had moderate to severe compulsive or repetitive behaviors. They received citalopram therapy (10-20 mg/day) or placebo for 12 weeks.
Citalopram therapy did not reduce repetitive behaviors or improve any other behaviors that they measured more than placebo. The authors tested more than 11 behaviors and skills using 3 different standard clinical tests.
Why is this important? For one thing, citalopram may be commonly prescribed for children with autism, though it is tough to know just how often. Pair that tidbit with the solid design study. The design is quite solid for this kind of study. They had 149 children in the study, placebo controls, double-blinded design, 12 weeks of drug therapy, and 3 standardized tests for 11 different behaviors. And they found no effect.
The second reason it is important is that this study also showed a noticeable “placebo effect.” The placebo effect is when people who take placebo in the study report having a response (either better or worse). In this study, 34% of children taking placebo showed improvement in the behavioral test scores. The patients and the researchers didn’t know which they were receiving (hence the term “double-blind”). So about 1/3 of the patients showed improvements, whether they took the placebo or the drug.