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Popular Antidepressant Treatment May Not Help Autistic Kids

By Hugh C. McBride

Many doctors prescribe the antidepressant citalopram (which is marketed in the United States under the brand name Celexa) for autistic children and teenagers in the belief that the drug will help relieve certain repetitive behaviors that afflict many young autism patients.

But a surprising new study has revealed that citalopram may not only be ineffective when taken by autistic children, but may actually increase repetitive movements while also inflicting side effects including diarrhea, insomnia, and hyperactivity.

A June 2 article by Karen Kaplan of the LA Times provided the following summary of the issues surrounding the finding that citalopram may not be an effective treatment for autistic children:

Roughly a third of all children diagnosed with autism in the U.S. now take citalopram, the antidepressant examined in the study, or others that are closely related.

The results of the nationwide trial, published in Archives of General Psychiatry, have some experts reconsidering the appropriateness of antidepressants and other mind-altering drugs used to treat children with autism spectrum disorders. ...

Because very few medications have been tested on autistic children in large, rigorous studies, doctors have looked to drugs that treat similar symptoms in other conditions, such as obsessive-compulsive disorder or attention-deficit hyperactivity disorder.

Celexa and Autism

Kaplan's LA Times article noted that autism remains "a group of poorly understood developmental disorders" that manifests itself with a range of impairments to a person's ability to communicate or otherwise engage in social interactions. Among the more obvious symptoms of disorders along the autism spectrum are repetitive physical or verbal behaviors – symptoms that doctors have believed they could treat by prescribing Celexa.

"Only one medication – the antipsychotic drug risperidone – has been approved by the Food and Drug Administration for the treatment of irritability and aggression in children with autism," Kaplan reported. "But doctors ... haven't shied away from giving other pharmaceuticals a chance."

Celexa is a selective serotonin reuptake inhibitor, a class of antidepressant medications that also includes Zoloft, Paxil, and Prozac. Celexa is most commonly prescribed to autistic patients because doctors believe that its active ingredient (citalopram) would be effective in treating certain autism symptoms. Neither Zoloft, Paxil, nor Prozac contain citalopram; instead, these popular SSRIs contain sertraline (Zoloft), paroxetine (Paxil), and fluoxetine (Prozac).

Though anecdotal evidence seemed to suggest that Celexa could help alleviate certain symptoms of autism, Shirley S. Wang of The Wall Street Journal noted that, prior to the recent research effort, "the effectiveness of antidepressants for children with autism hadn't been well-studied."

About the Citalopram Study

According to a June 1 article on the Forbes magazine website, the research that has cast doubt upon citalopram's effectiveness with autistic children was conducted under the direction of Dr. Bryan King, the director of psychiatry and behavioral medicine at Seattle Children's Hospital and the University of Washington.

Dr. King's research team reached the surprising conclusion about citalopram and autism after engaging in a three-month study:

  1. They randomly gave either Celexa (average dose of 16.5 milligrams) or a placebo to 149 autistic young people between the ages of 5 and 17.
  2. The autistic children who participated in Dr. King's study took Celexa or a placebo for three months. One hundred twenty-three autistic children (82.5 percent of the group that began the study) completed all three months of the study period.
  3. The number of children who improved (which was defined as not engaging in as many repetitive behaviors) was about a third in both groups. This indicated that citalopram was no more effective than the placebo.

"We didn't expect [citalopram] to work for everyone, but we were hoping that we'd be able to drill down into the population for whom it was very helpful and begin to identify the predictor of what a positive response would be," Dr. King told Forbes.

Questioning the Results of the Citalopram Study

In Shirley S. Wang's June 2 Wall Street Journal article, the director of the National Institutes of Health said Dr. King's study casts significant doubt upon the efficacy of citalopram for use with autistic children.

"I do think the results from this study don't encourage the use of this medication for repetitive behaviors in autism," said Thomas Insel.

Other experts still have their doubts about whether Celexa is really ineffective when prescribed to autistic children.

In the Forbes article, Dr. Andrew Zimmerman, a pediatric neurologist and director of medical autism research at the Kennedy Krieger Institute in Baltimore, defended the ability of Celexa to have a positive impact on young autistic children.

"If you start at a very low dose and build it up slowly, you see improvements in mood and decreases in repetitive behaviors," said Dr. Zimmerman, who has used Celexa to treat autistic children between the ages of 3 and 5. "The kids are more attentive."

In a written statement, Celexa's manufacturer, Forest Laboratories Inc., reported that the company "was not involved in this study and therefore cannot provide comment."

Nonmedical Approaches to Dealing with Autism

The Celexa controversy nonwithstanding, medical science continues to work toward a greater understanding of the causes and potential treatments for the various disorders that comprise the autism spectrum. In addition to researching medications to alleviate or eradicate autism symptoms, experts have developed a number of nonmedical approaches to help children with autism, Asperger's Syndrome, and other autism spectrum disorders.

For example, for more than 25 years, Talisman Camps and Programs in Zirconia, North Carolina, has been providing innovative experiential wilderness programs for autistic children and those with similar disorders. Emphasizing structure and accountability in a nurturing and supportive environment, Talisman offers both semester-length and summer programs for children with high-functioning autism, Asperger's Syndrome, Attention Deficit Hyperactivity Disorder (ADHD), and certain learning disorders.

From medication-based approaches to educational support to behavioral therapy, parents of children with autism, Asperger's Syndrome, and related conditions have a wide range of options to consider when determining the best course of treatment for their children.


 

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