Antidepressant ineffective against autism spectrum disorder children's obsessive

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http://www.eurekalert.org/pub_releases/2009-06/nsij-aia060109.php

Public release date: 1-Jun-2009

Contact: Talan

North Shore-Long Island Jewish (LIJ) Health System

Antidepressant ineffective against autism spectrum disorder children's obsessive

behavior

MANHASSET, NY – A new multi-center study, conducted at The Feinstein Institute

for Medical Research in collaboration with five other centers throughout the

country, tested the commonly prescribed antidepressant citalopram and found that

it was no more effective than placebo in altering obsessive features of the

condition – the spinning, rocking and repetitive behavior.

Like everything in medicine, the use of antidepressants in children with autism

spectrum disorder took off before there was strong scientific proof about its

effectiveness. In the last decade, its use has grown so that today more than 40

percent of autistic children swallow a daily dose of an antidepressant.

This study, published in the June 2009 issue of Archives of General Psychiatry,

should serve to reduce the number of antidepressant prescriptions written for

children with autism and similar conditions on the autism spectrum.

" Parents of children with autism spectrum disorders face an enormous number of

treatment options, not all of which are research based, " said R. Insel,

MD, Director of the National Institute of Mental Health (NIMH). " Studies like

this help us to better understand which treatments are likely to be beneficial

and safe. " The study was funded by the NIMH and other NIH institutes.

The Feinstein Institute's D. Bregman, MD, an expert on autism and one of

the study investigators, said that the initial use of antidepressants grew out

of a belief that some of the repetitive behaviors are similar to those seen

among people with obsessive compulsive disorder. " We can't rely on apparent

similarities to other conditions and clinical experiences to guide our treatment

strategies. " Dr. Bregman said. " This was a large double-blind clinical trial

that showed that this class of medicine is not effective in reducing these

behaviors. These types of studies are essential. "

The study followed 149 children between the ages of five and 17. About half were

given a placebo dose and the others received the antidepressant. They were

tested repeatedly over the 12-week study period. A positive response was defined

by improvement on a number of behavioral measurements. " There was no significant

difference in the rate of positive response " on these tests, the scientists

concluded. " Results of the trial do not support the use of citalopram for the

treatment of repetitive behavior in children and adolescents with autism

spectrum disorder. "

Citalopram is in a class of antidepressant medicines called selective serotonin

reuptake inhibitors (SSRIs).

Initial smaller studies reported that SSRIs did make a difference. There is some

biologic evidence to suggest that it would. Scientists have reported

abnormalities in the brain regions that make the chemical serotonin. And people

with obsessive compulsive disorder (OCD) also have serotonin abnormalities and

often respond to the medication that helps the serotonin cells to function more

normally. SSRIs are the most frequently prescribed medications for children with

autism, Asperger disorder, or pervasive developmental disorder-not otherwise

specified (PDD-NOS) spectrum disorder.

Part of the explanation for the mixed study results is that the placebo response

is very high. In the latest study, one in three children in both groups—32.9

percent of those treated with citalopram and 34.2 percent of those treated with

placebo—were reported to have fewer or less severe symptoms.

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The authors on the paper included: H. King, MD, Seattle Children's

Hospital; Hollander, MD, Mount Sinai School of Medicine; Linmarie Sikich,

MD, University of North Carolina, Chapel Hill; T. McCracken, MD,

University of California Los Angeles; Lawrence Scahill, MSN., PhD, Yale

University; Dr. Bregman, MD, of the Feinstein Institute and North Shore Long

Island Jewish Health System; Craig L. Donnelly, MD, Dartmouth Medical School;

Evdokia Anagnostou, MD, Mount Sinai School of Medicine (currently at the

University of Toronto); Dukes, PhD, DM-STAT; Sullivan, PhD, Boston

University; Deborah Hirtz, MD, National Institute of Neurological Disorders and

Stroke (NINDS); Ann Wagner, PhD, NIMH; Louise Ritz, MBA, NIMH (currently at

NINDS); and the STAART Psychopharmacology Network, a novel federal initiative.

About The Feinstein Institute for Medical Research

Headquartered in Manhasset, NY, The Feinstein Institute for Medical Research is

home to international scientific leaders in cancer, leukemia, lymphoma,

Parkinson's disease, Alzheimer's disease, psychiatric disorders, rheumatoid

arthritis, lupus, sepsis, inflammatory bowel disease, diabetes, human genetics,

neuroimmunology, and medicinal chemistry. Feinstein researchers are developing

new drugs and drug targets, and producing results where science meets the

patient, annually enrolling some 10,000 subjects into clinical research

programs.