A new study suggests that antidepressants such as Prozac and Zoloft, often prescribed to children and adults with autism, are ineffective in managing autistic symptoms. The study is actually a compilation of findings from earlier studies, some of which are small and only one of which is described as "large and robust."
The focus of the study was on the ability of antidepressants (SSRI's) to actually reduce "core symptoms of autism." These symptoms are described specifically as problems with social interaction, communication and self-injurious behavior. It's important to note that SSRI's are not typically prescribed as a tool for improving these challenges.
According to the study summary:
There is no evidence to support the use of SSRIs to treat autism in children. There is limited evidence, which is not yet sufficiently robust, to suggest effectiveness of SSRIs in adults with autism. Treatment with an SSRI may cause side effects. Decisions about the use of SSRIs for established clinical indications that may co-occur with autism, such as obsessive compulsive disorder and depression in adults or children, and anxiety in adults, should be made on a case by case basis.
Bottom line: children with autism who do not exhibit symptoms of obsessive compulsive disorder or depression are unlikely to benefit from SSRI's, and ARE at risk of serious side effects. If your child is prescribed an SSRI, be absolutely certain that the medication is appropriate for his/her symptoms, and that there are no other, safer alternatives. Ask your doctor about potential side effects, and carefully record any positive or negative changes you see from the medication.
This falls into the realm of ‘questionable wording’ like many things in the Autism realm.
I don’t think anyone ever used anti-depressants “to treat Autism”… you’d have to be pretty silly to think that they’d do anything good for Autism at all.
However, some of the symptoms or effects of Autism, such as depression… certainly could benefit from anti-depressants since, well.. that’s what they are intended to do, treat depression.
They word these “findings” with very suspect headlines so as to get the most attention.. either that, or they really had no idea what they were doing when they started the study.
Actually Stuart – and correct me, folks, if I’m wrong here – I believe that SSRI’s are in fact often used for kids with autism because there is a misunderstanding on the part of some practitioners that the anxiety and repetitive behaviors that are a part of autism are the result of mental health issues.
My guess is that a pediatrician without specific autism-related experience might assume that anxiety or behavior issues are caused by chemical imbalances that could be alleviated with medication. But from my understanding this is rarely the case – and more often these issues are better treated through a combination of changes to the environment (less noise, light, etc.), behavioral therapy and/or play therapy, occupational and/or sensory integration therapy, etc.
Too often, autistic behaviors LOOK like intentional misbehavior, ADHD, or anxiety disorder.
Lisa
Lisa,
My understanding that SSRI antidepressants are the second most commonly prescribed group of drugs to people with autism behind antipsychotics, despite the drugs never having been officially approved to treat autism. I think the rationale for prescribing them was brought on by studies that showed a large percentage of people with autism had higher than normal levels of seritonin in their systems. Since this group of drugs inhibits the uptake of seritonin in the brain, there is/was a belief that they could be an effective treatment for the core symptoms of autism. I think this is a belief that has (thankfully) been slowly falling off in recent years.
I, like Stuart, had always assumed these drugs were prescribed for comorbid symptoms. I am confused, Lisa, about your description of Anxiety, I think. Along with my AS, I suffer GREATLY from Anxiety disorders. Perhaps it’s because of PTSD and General Anxiety Disorder that I’m prescribed a mixture of SSRIs, tetracyclics and anti-anxiety medications. I do notice that my OCD and Social Anxiety symptoms are largely unaffected by whatever medication I use. I’m sure this has something to do with the innate nature of those being part of my Asperger’s presentation.
My point, there are definitely Anxiety symptoms that are treated quite well with antidepressants in some Autistic adults. I know of other people who use a mix for similar symptoms. Again, a lot of that’s treated is PTSD and GAD though.
Melody – I’m not an expert on the subject of medications, and I do know that issues like anxiety, depression and compulsion can result from a number of different issues. I assume that the source of the issue has huge implications for the selection of a treatment.
Lisa
I believe that an FDA warning in 2003 linked the use of SSRIs to suicide risk in children. Perhaps later studies disproved the association, but I would be wary of using them in a child, unless safety and efficacy studies had shown that the drug was, well, effect and safe!
I am personally aware of one case of a 7-year-old who was prescribed an SSRI off label on a trial basis in an attempt to treat autism-related self-injurous head banging. The parents noted that the drug did not appear to diminish the symptoms and also noted other undesireable side effects and refused to continue with the drug after the trial period ended.
I believe much of the anxiety comes from sensory issues. My daughter has sensory processing disorder, which is nearly always comorbid with autism, and she becomes anxious when experiencing sensory overload. Sometimes it looks like depression – she is only six. Take away the sensory issues and she looks normal and happy. I like what the Brain Balance website has to say about functional disconnection syndrome, the underlying brain issue in autism and adhd, and how it can be reversed… http://www.brainbalancecenters.com/the-truth/
With some searching, I did find one article from 2000 that clearly indicates an attitude of treating core symptoms of autism with antidepressants. The logic regarding serotonin is reversed from what I stated in my previous post and I apologize for remembering it backwards. However, the article does verify that there was, at least at one time, a tendency to try to treat more than comorbed depression in people with autism by using antidepressants.
http://findarticles.com/p/articles/mi_m1272/is_2665_129/ai_66011862/
@Malia – That’s very scary to me. I can understand treating comorbids and using medication for that purpose. For the purpose of treating symptoms that are not part of those comorbids seems illogical. I know there’s things like insomnia that are often treated with antidepressants since many of them cause drowsiness. Those sort of purposes seem very logical.
But to jump from headbanging to self-injurous suicidal indications seems like a huge leap of logic that has no basis in reality. That’s the only leap I can make to justify using antidepressants to treat headbanging. But that would require the child to have the understanding of death when they started headbanging. Sorry. I’m rambling now. But you get my point.
This goes back to my issues with how many people treat Autistic symptoms altogether.
I agree Melody. It scares me, too and I’m glad to see some stronger studies that support discontinuine whatever remnants of this practice might still exist “out there” – both in the minds of parents and various doctors who may still be holding onto old information.
I think some doctors use medicine that would treat something else as an approach for other things, like Lupron and autism for instance. There’s many drugs that people tend to target towards autism and become an ‘autism treatment’. Years back a mother was considering Prozac even though her child never displayed any symptom’s for the use of it. The mom hoped the drug would help her child to be verbal. It’s not just the doctors, it’s parents as well.
For years I have been telling people “there is no such thing as an autism drug or medicine”. And really, there isn’t. I believe the use of antidepressants more came about from the asking by parents.
My son is on 2 different antidepressants to target 2 different issues maybe related to autism but probably not. The autism behaviors and symptom’s are still present, however the 2 target issues greatly imporved with the use of antidepressants.
Don’t under estimate the potential good outcomes that antidepressants can have, when used appropriately.
I believe there are those that “do” experience some recovery with the methods associated with the Mccarthy group. We hear of one mistaken drug used in chelation, and rant over it for years, yet suicide among those taking antidepressants is real enough to require a black box label. In a recent study, approx. 1.3% of the children on these drugs attempted suicide . My neighbor lost his 16 yr old asd child to suicide, and while his failed attempts should have called for stopping the drug, the psychiatrist said he needed it and kept the rx going. The Dad told me this, before the child died, when I pleaded with him to consider this new suicidal behavior as a drug reaction. HE WAS NOT SUICIDAL before the antidepressants.
I personally know a 4 year old boy with autism who was unable to walk through doorways, interact, and would have constant meltdowns. He was treated with Prozac and now you can’t even tell he had any issues at all. His mom says it’s like he’s a completely different person and no longer has any anxiety issues. We have had several play dates before and after treatment and the change is remarkable. He would never speak to anyone or touch them, let alone play with anyone and now he holds hands with peers and chats and plays. I believe that the autism spectrum is so vast that truly treatment must be done on a case by case basis.
My son is 3 yrs old, he has autism among several other diagnoses and we recently (hesitantly) put him on an extremely low dose of prozac. (This decision was reached after ALL alternatives were exhausted. He was displaying severe anxiety and OCD tendencies ie he would bite his fingernails and toenails until he bled and then continue to bite while crying bc he just couldnt stop)
I am happy to say that it has been 5 weeks, and this behavior has disappeared! Our son seems happier, carefree even! Of course he is still autistic, non verbal, and has extreme sensory and diet issues, but the anxiety is gone!! Thank God!
I have so far not observed any obvious side effects, but will continue to monitor him. I believe that the decision to put our children that are on the spectrum on these types of drugs should definitely be on a case-by-case basis.