Benefits of Antidepressants in Autism Overstated?
Study Finds Parents and Doctors Don’t Have All the Facts About How Well the Drugs Work
Evidence of 'Publication Bias' continued...
That's because many medical journals are reluctant to publish studies that show a medication or treatment doesn't work. It's a problem called publication bias. And it's sometimes a good indication that those studies may have found that the medications were not effective.
When researchers adjusted their results to account for the unpublished studies and the risk of publication bias, the apparent benefit of the medications was cut in half. It dropped from reducing symptoms about 22% compared to a placebo, to reducing them just 12%, a difference that could have occurred just by chance and may not have been an actual benefit of taking the medication.
"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 if the reason why they didn't get published is because they had negative results," says Carrasco.
Publication bias "makes it more difficult for clinicians to make accurate assessments about the potential benefits of new treatments," says Andrew Adesman, MD, chief of developmental and behavioral pediatrics at the Steven and Alexandra Cohen Children's Medical Center in New Hyde Park, N.Y.
But he says there are other reasons, beyond repetitive behaviors, that doctors might prescribe an SSRI in autism. They are sometimes used to help anxiety, for example, he says, and the study didn't address that.
Advice to Parents of Autistic Children
"For parents," Carrasco says, "based on the available data that we have, it seems that perhaps a group of medications called SRIs that are widely used to treat these symptoms, it seems that perhaps they are not as efficient at treating these symptoms as we previously thought they were."
That's unfortunate, she says, because there really aren't many other medications that help repetitive behaviors.
Other experts say the best thing for parents to do, especially if they have a child who's taking an antidepressant and doing well, is to keep doing what's working.
"If there's uncertainty about the benefits of these medications," Adesman says, "then maybe family and clinicians need to be more mindful of this."