Antidepressant No Help for Autism Behaviors
Celexa for Autism No More Effective Than Placebo at Reducing Repetitive Behaviors, Study Shows
Treating Repetitive Behaviors: Other Opinions
In a commentary accompanying the study, Fred R. Volkmar, MD, of the Yale Child Study Center, speculates that the findings may change the widespread practice of prescribing antidepressants for children with autism and ASD.
Although the researchers note in the report of the study that different results might have been obtained with larger numbers of children, Volkmar says the King study is believed to be the largest such trial of the SSRIs in children with autism or ASD.
''It's important to realize the door is not necessarily closed on SSRIs,'' Volkmar tells WebMD. Other SSRI drugs may be found to help, says Volkmar, the Irving B. Harris Professor at Yale.
The study finding also suggests that researchers should explore why the SSRI drugs seem to work well overall in adults but not always in children, he says.
Forest Laboratories, which makes Celexa, says in a statement, "Forest Laboratories was not involved in this study and therefore cannot provide comment."
The results are ''disappointing," says Thomas Insel, MD, director of the National Institute of Mental Health. "The bottom line is, it doesn't sound like the medication is any better than placebo."
Because repetitive behaviors can be a significant problem, he says, "The question is, is there something else that can be used?"
Because Celexa didn't work for the autism-related repetitive behaviors but does work for those associated with obsessive-compulsive disorder, Insel says the findings may yield a clue that the behaviors are fundamentally different in some way.
Another expert, Geraldine Dawson, PhD, chief science officer for Autism Speaks, an advocacy and research organization, agreed that the study suggests the "underlying biology" is different for obsessive-compulsive disorder and autistic behaviors. The study finding "really does suggest that this drug is not going to be helpful for repetitive behaviors," she says.
Earlier this year, Autism Speaks released initial results of its study of another SSRI, Prozac, finding it also not effective in reducing repetitive behaviors compared to placebo. However, the study is continuing.
Implications for Treatment & Advice for Parents
Although other SSRIs may result in a different effect, King says, there is not enough research right now to make a clear recommendation about SSRIs as a class of drugs to treat repetitive behaviors associated with autism.
And what should parents do if their child is doing well on an SSRI prescribed to reduce repetitive behaviors? "It's very hard to argue with improvement," King tells WebMD. "If a child is taking an antidepressant and seems to be doing very well, you do not want to summarily discontinue treatment for that child."
But he does suggest that parents talk to their child's health care provider and consider the possibility of taking the child off the drug to see if the benefit remains. The improved behavior may not be tied to the medication, King says.
Repetitive behaviors related to autism can have an "ebb and flow," Insel says. Children may have been enrolled in the trial when their symptoms are somewhat worse and their symptoms may have improved over time even without the medication.