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Where I Am: Home | Interventions | List | Anti-depressants And Autism

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Anti-Depressants and Autism

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Ranking :

Type(s) : Medication

Other Names :

• Anti-Depressives
• MAOIs
• Monoamine Oxidase Inhibitors
• Tricyclics
• Selective Serotonin Reuptake Inhibitors
• SSRIs

Introduction

Anti-depressants are medications which increase the level of active neurotransmitters in the brain. They are used to treat people with depression, anxiety or other mental health problems.

Anti-depressants are sometimes used to treat people with autistic spectrum disorders who have mental health problems. They may also be used to treat people with ASD who have other problems, such as repetitive behaviours or social deficits.

Opinion

There is insufficient information on the effects of SSRI and Tricyclic antidepressant drugs on specific autistic abnormalities in adults to make a clear recommendation. The evidence from published studies suggests that they may reduce repetitive behaviours. Large scale methodologically adequate trials are needed that examine pre-specified autistic outcomes.

The use of antidepressant drugs to treat autistic abnormalities in children cannot be recommended on the basis of current evidence and because there are concerns about the harm due to SSRI induced activation and agitation. Their use should only be considered in specialist settings taking particularly into consideration subject selection and dosage. Methodologically sound studies are needed.

Further information

Please see the Trials page for details of the research studies we used to rank this intervention and the Ranking page for details of how we ranked those studies.

Disclaimer

Please read our Disclaimer about this intervention.

Audience

Adults, including those with autistic spectrum disorders, who are suffering from depression or anxiety or from symptomatic problems of autism for which antidepressant medication may be beneficial.

Evidence on the effects of antidepressants in older adults is almost entirely absent. Most clinical evaluation evidence is based on children and younger adults.

Applicable Age Ranges

Aims

The precise action of anti-depressants in relieving symptoms of depression is unknown.

It is believed that anti-depressants act by increasing the level of the active neurotransmitters such as Noradrenaline and or 5-Hydroxy Tryptamine or both in the brain.

Antidepressant drugs are effective in adults in the treatment of major depression of moderate and severe degree including major depression associated with physical illness. They are also effective for dysthymia (lower grade chronic depression).

Some anti-depressants are also licenced for use in the treatment of anxiety and related disorders, such as chronic anxiety, generalised anxiety disorder and panic disorders in adults.

Claims

Some researchers claim that anti-depressants can bring about significant improvements in the symptoms of depression and anxiety in people with autism.

Some researchers also claim that anti-depressants can be used to alleviate other problems faced by people with autism, including

• anger, irritability and aggression
• self-injurious behaviour
• inattention and hyperactivity

Some researchers also claim that anti-depressants may improve some of the symptomatic problems of autism, such as

• repetitive thoughts, actions and interests
• social deficits, including language and communication skills deficits

Detail

Anti-depressants change the level of certain chemicals in the brain called neurotransmitters. Normally, these chemicals pass signals from one brain cell to another. It is believed that in depression, some of them don’t work properly. Anti-depressants increase the level of active neurotransmitters.

There are four main types of anti-depressants, each of which works slightly differently, and each of which may produce different results and side-effects.

• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Tricyclic Antidepressants
• Monoamine Oxidase Inhibitors (MAOIs)
• Other Antidepressants

As with any treatment for depression, adjustments may have to be made under expert medical supervision to find the appropriate drug and dosage for the individual. The side effects need to be monitored and effort made to ensure the benefits of the treatment outweigh the disadvantages.

In general the newer SSRI anti-depressants should be chosen over the older Tricyclics. SSRIs are safer and produce less severe side effects.

MAOIs should only be used under the direction of a specialist in the treatment of complex affective disorders as there are major risks associated with their use in combination with other medications and certain types of food and beverages.

Antidepressants have not been shown to be effective in childhood with the possible exception of the SSRI Fluoxetine where the benefits may outweigh the risks in adolescents.

Time

Treatment with antidepressants usually starts with a Selective Serotonin Reuptake Inhibitor (or less often with a Tricyclic Antidepressant). It takes about 10 to 14 days for the drugs to start working, and six to eight weeks for them to fully take effect.

Individuals vary in their response to particular antidepressants. If there is no benefit it may be necessary to increase the dose or change to a different antidepressant.

Involvement

This intervention requires relatively little carer or professional time once the initial prescription has been made. However the side effects need to be monitored and effort made to ensure the benefits of the treatment outweigh the disadvantages

Costs

Anti-depressants are available free of charge to patients within the NHS in the UK.

Credentials

Anti-depressants are very powerful drugs with many potential side effects and contradictions. For this reason they should only be obtained on prescription from a GP or other qualified medical professional.

Availability

Anti-depressants should only be obtained on prescription from a GP or other qualified medical professional.

Hazards

There are very many different anti-depressants on the market, each of which may have adverse effects. The most common side effects include drowsiness, blurred vision, nausea and vomiting. However, this usually settles down as an individual gets used to the drug.

The doctor prescribing an anti-depressant and the dispensing pharmacist can provide a list of unwanted effects and explain these.

Contraindications

Some anti depressants are not appropriate for certain groups of people including children and adolescents.

History

Antidepressant effects were first discovered fortuitously (and through careful observation). It was also noticed that certain drugs caused severe depression in otherwise mentally well adults. Modern antidepressants such as the SSRI group were developed by the pharmaceutical industry.

Accounts

We have been unable to identify any personal accounts for the use of anti-depressants to treat problems in people with autism.

Research

We have identified more than 40 studies of anti-depressants and people with autistic spectrum disorders published in peer-reviewed journals, most of which described the treatment of a few users. These studies included a total of several hundred children and adults. Most of the studies reported positive results but very few compared outcomes with a comparison group of consenting patients given a placebo, which is an inactive pill that looks the same as the active treatment.

Only three of the studies were adequately designed and reported treatment trials on autism specific health outcomes. The results suggest that in adults antidepressants may relieve repetitive behaviours. The effects of antidepressants on their impact on anxiety and depression has not been studied specifically in adults with autistic disorders but their use for these conditions can be considered when indicated as they would be in adults in general.

We have yet to evaluate the study by Coskun and Mukaddes (2008).

Trials

• All Anti-Depressants and Autism

SSRIs and Autism

• Citalopram and Autism
• Clomipramine and Autism
• Escitalopram and Autism

• Fluoxetine and Autism
• Fluvoxamine and Autism
• Paroxetine and Autism
• Sertraline and Autism
• Venlafaxine and Autism

SSREs and Autism

• Tianeptine and Autism

Tricyclics and Autism

• Imipramine and Autism
• Nortriptyline and Autism

Tetracyclics and Autism

• Mirtazapine and Autism

Future

Randomised controlled clinical trials of the effects of antidepressants on depression and anxiety disorders should be carried out on adults who also have autistic spectrum conditions to determine their effectiveness and optimal dose range. Further trials on adolescents are needed before it is possible to recommend trials in adolescents with autistic disorders.

Autism specific outcome measures for use in adults need to be developed and tested for their reliability and validity as measures of change that is clinically relevant and that users endorse as representing their aims for improved health. Clinically relevant outcomes may include intrusive repetitive behaviours, outbursts of behaviour that be harmful to the person, others or valuables and difficulties in achieving desired and appropriate social contact and communication with others.

Carefully planned randomised controlled trials of the effects of antidepressants on prespecified autism specific outcomes are needed in adults at lower as well as at higher levels of functioning.

Summary

There is some evidence from a small number of published trials to suggest that anti- depressants may reduce repetitive behaviours.

Large scale methodologically adequate trials are needed that examine pre-specified autistic outcomes.

Reading

• Bates G., Willson S.W.(2003). ‘Use of selective serotonin reuptake inhibitors in children with pervasive developmental disorder: risk of treatment emergent mania’. Developmental Medicine and Child Neurology. 45(5), p.359; author reply p.360.
• Campbell M.(1975). Pharmacotherapy in early infantile autism. Biological Psychiatry. 10(4), pp. 399-423.
• Campbell M., Cueva J.(1995). Psychopharmacology in child and adolescent psychiatry: a review of the past seven years: Part 1 Journal of the American Academy of Child and Adolescent Psychiatry. 34(9), pp. 1124-1132. Read Abstract (New Window)
• Dinca O., Paul M., Spencer N.(2005). Systematic review of randomized controlled trials of atypical antipsychotics and selective serotonin reuptake inhibitors for behavioural problems associated with pervasive developmental disorder. Journal of Psychopharmacology. 19(5), pp. 521-532. Read Abstract (New Window)
• Hollander E.(1998). Treatment of obsessive-compulsive spectrum disorders with SSRIs. British Journal of Psychiatry Supplement. 35, pp. 7-12. Read Abstract (New Window)
• Hollander E., Phillips A., Yeh. C.(2003). Targeted treatments for symptom domains in child and adolescent autism. Lancet. 362(9385), pp. 732-734. Read Abstract (New Window)
• Jorgensen O.(1979). Psychopharmacological treatment of psychotic children. A survey. Acta Psychiatrica Scandinavica. 59(2), pp. 229-238. Read Abstract (New Window)
• King B.H., Bostic J.Q.(2006). An update on pharmacologic treatments for autism spectrum disorders. Child and Adolescent Psychiatric Clinics of North America. 15(1), pp.161-175. Read Abstract (New Window)
• Kolevzon A., Mathewson K., Hollander E.(2006). Selective serotonin reuptake inhibitors in autism: a review of efficacy and tolerability. Journal of Clinical Psychiatry. 67(3), pp. 407-414. Read Abstract (New Window)
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• Moore M.L., Eichner S.F., Jones J.R.(2004). Treating functional impairment of autism with selective serotonin-reuptake inhibitors. Annals of Pharmacotherapy. 38(9), pp. 1515-1519. Read Abstract (New Window)
• Myers S.M.(2007). The status of pharmacotherapy for autism spectrum disorders. Expert Opinion on Pharmacotherapy. 8(11), pp. 1579-1603. Read Abstract (New Window)
• National Health Service(2006). Anti-depressants. London: National Health Service. Read Full Item (New Window)
• National Institute for Health and Clinical Excellence(2004). Depression: management of depression in primary and secondary care. Clinical Guideline 23. London: National Institute for Health and Clinical Excellence. Read Full Item (New Window)
• National Institute for Health and Clinical Excellence(2005). Depression in children and young people: identification and management in primary, community and secondary care. Clinical Guideline CG28. London: National Institute for Health and Clinical Excellence.
• National Institute of Mental Health(2007). Anti-Depressants. Bethesda, MD: U.S. National Library of Medicine. Read Full Item (New Window)
• Posey D.J., McDougle C.J.(2000). The pharmacotherapy of target symptoms associated with autistic disorder and other pervasive developmental disorders. Harvard Review of Psychiatry. 8(2), pp. 45-63. Read Abstract (New Window)
• Posey D.J., McDougle C.J.(2001). Pharmacotherapeutic management of autism. Expert Opinion on Pharmacotherapy. 2(4), pp. 587-600. Read Abstract (New Window)
• Posey D.J. et al. (2006). The use of selective serotonin reuptake inhibitors in autism and related disorders. Journal of Child and Adolescent Psychopharmacology. 16(1-2), pp. 181–186. Read Abstract (New Window)
• Posey D.J., Erickson C.A., McDougle C.J.(2008). Developing drugs for core social and communication impairment in autism. Child and Adolescent Psychiatric Clinics of North America. 17(4), pp. 787-801. Read Abstract (New Window) Read Full Item (New Window)
• Santosh P.J., Baird G.(2001). Pharmacotherapy of target symptoms in autistic spectrum disorders. Indian Pediatrics. 68(5), pp. 427-431. Read Abstract (New Window)
• Scahill L., Koenig K.(1999). Pharmacotherapy in children and adolescents with pervasive developmental disorders. Journal of Child and Adolescent Psychiatric Nursing. 12(1), pp. 41-43. Read Abstract (New Window)
• Self T.L., Hale L.S., Crumrine D.(Epub ahead of print). Pharmacotherapy and children with autism spectrum disorder: A tutorial for speech-language pathologists. Language, Speech, and Hearing Services in Schools. Read Abstract (New Window)
• Soorya L., Hollander E., Kiarashi J.(2008). Psychopharmacologic interventions for repetitive behaviors in autism spectrum disorders. Child and Adolescent Psychiatric Clinics of North America. 17(4), pp. 753-771. Read Abstract (New Window)
• Stigler K.A., Posey D.J., McDougle C.J.(2002). Recent advances in the pharmacotherapy of autism. Expert Review of Neurotherapeutics. 2(4), pp. 499-510. Read Abstract (New Window)
• Tandon M., Pruett J.(2008). An overview of the use of antidepressants in children and adolescents. Missouri Medicine. 105(1), pp. 79-84. Read Abstract (New Window)
• Tsai L.(1999). Psychopharmacology in autism. Psychosomatic Medicine. 61(5), pp. 651-665. Read Abstract (New Window) Read Full Item (New Window)
• West L., Waldrop J., Brunssen S.(2009). Pharmacologic treatment for the core deficits and associated symptoms of autism in children. Journal of Pediatric Health Care. 23(2), pp. 75-89. Read Abstract (New Window)
• West L., Brunssen S., Waldrop J.(2009). Review of the evidence for treatment of children with autism with selective serotonin reuptake inhibitors. Journal for Specialists in Pediatric Nursing. 14(3), pp. 183-191. Read Abstract (New Window)
• Williams K.J. et al. (2010). Selective serotonin reuptake inhibitors (SSRIs) for autism spectrum disorders (ASD). Cochrane Database of Systematic Reviews. (8), CD004677. Read Full Item (New Window)

Issues

Keywords

Anti Antidepressants Citalopram Clomipramine Depressant Depression Depressed Desipramine Escitalopram Fluvoxamine Fluoxetine Imipramine Inhibitors MAOIs Mirtazapine Monoamine Nortriptyline Oxidase Reuptake Selective Serotonin Sertraline SSRIs Tianeptine Tricyclic Venlafaxine

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