Antidepressant Medications Not Necessarily the Best Solution for Children with Autism

Autism spectrum disorders, World Autism Awareness Day, Autism Speaks
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Selective serotonin reuptake inhibitors (SSRIs) are most often prescribed for symptoms of anxiety and depression in children with an autism spectrum disorder (ASD). However, an analysis of completed trials find that these antidepressant are not always the best solution, with researchers calling them “overrated” in terms of treating autism.

People with an ASD are particularly vulnerable to mental health problems such as anxiety and depression, says the National Autistic Society, the UK’s leading charity for people affected by the disorders. Unfortunately, our current knowledge about depression in youth is limited, especially in developmental disorders where the individual who is unable to communicate his or her feelings of anxiety or distress.

Melisa Carrasco PhD of the University of Michigan in Ann Arbor and colleagues compiled the data from five published articles and one unpublished completed that used antidepressant medications known as SSRI’s, a class of drugs that include citalopram (Celexa), fluoxetine (Prozac) and fluvoxamine (Luvox), or tricyclic antidepressant medications such as clomipramine (Anafranil). Both types of medications work by altering serotonin levels in the brain. Four other unpublished trials were considered, but data requested from these trials was not supplied to the researchers.

Overall, the six trials included 365 patients.

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Unfortunately, what the researchers found was publication bias – the trials showing positive results were much more likely to be published than those showing that the drugs were ineffective for the treatment of autism symptoms. The five published studies showed about a 20% success rate in reducing repetitive behaviors such as obsession and compulsion, but when the data from the sixth unpublished study was included, success rate dropped to only 12% - statistically insignificant as it is just beyond the margin of error.

Researchers say that they believe many journals are reluctant to publish studies showing drugs do not work, especially in the case of autism.

Dr. Carrasco says, "When we realized there were as many unpublished studies with data as there were published studies providing data, it was definitely a little frustrating ... It definitely brings up a huge problem in this field. There's really no umbrella organization that's overseeing that everybody who gets funding to do these studies, that they go ahead and then report it publicly. This is not rigorously enforced.”

“It makes you wonder what data is not available and how it could help us better treat kids," noted Dr. Carrasco.

The drugs, however, may be useful with co-morbid anxiety but the point is to ensure that your child is on the medications that benefit him or her, and not taking those that are not. As mentioned, certain medications can have significant side effects. Tricyclic antidepressants, for example, can increase drowsiness and reduce activity levels. There is also the about parents paying for medications that aren’t really necessary.

Source references:
Carrasco M, et al "Pharmacologic treatment of repetitive behaviors in autism spectrum disorders: Evidence of publication bias" Pediatrics 2012; DOI: 10.1542/peds.2011-3285.
Shamliyan T, Kane R "Clinical research involving children: Registration, completeness, and publication" Pediatrics2012; DOI: 10.1542/peds.2010-2847.
Denne S "Pediatric clinical trial registration and trial results: An urgent need for improvement" Pediatrics 2012; DOI: 10.1542/peds.2012-0621.

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