S. L. Baker
Thursday, June 18, 2009
Despite the fact the U.S. Food and Drug Administration (FDA) has not approved any prescription medications to treat the symptoms of autism and related disorders, drugs are frequently — and increasingly — being given to autistic children, according to a study in the June issue of Archives of General Psychiatry. An especially popular medication for autistic kids is the antidepressant citalopram, sold under the brand name Celexa, a selective serotonin reuptake inhibitor (SSRI), which interferes with the way the brain regulates the neurotransmitter serotonin.
Celexa supposedly reduces the occurrence of repetitive behaviors in children and teenagers with autism and related condition. At least, that’s the reason countless doctors have said they were prescribing it for autistic youngsters. The problem is, the new research shows the drugs do absolutely nothing to help. And a careful reading of the study’s conclusion shows the drug makes autistic kids’ repetitive behavior symptoms worse.
Children with autism often demonstrate the same actions over and over, like repetitive play and sticking to inflexible routines. The behaviors usually continue over time. “Because of suggested similarities between repetitive behavior in autism spectrum disorders and obsessive-compulsive disorder and the findings of serotonin system abnormalities in autism, anti-obsessional agents such as SSRIs have long been of interest,” the authors write. “Despite the relative dearth of evidence supporting their use, SSRIs are among the most frequently used medications for children with autism, partially because of their perceived safety.”
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Bryan H. King, M.D., of Seattle Children’s Hospital and the University of Washington, Seattle, and his research team set out to find evidence about how the SSRI might affect those with autism. The scientists conducted a randomized controlled trial to document the safety and efficacy of citalopram in children with autism spectrum disorders who had moderate or higher levels of repetitive behavior. Out of a group of 149 research subjects with autism spectrum disorders between the ages of 5 to 17, 73 were randomly assigned to receive citalopram (taking a typical average maximum dosage of 16.5 milligrams per day). Another control group received an inactive placebo for 12 weeks.
After the three month treatment period was over, the scientists could find no improvement in the group treated with citalopram when compared to the kids in the placebo group. However, there were differences in the two groups of youngsters — the ones on the SSRI had far more problems after taking the drug than the kid who didn’t. In fact, instead of halting repetitive movement, citalopram actually increased a form of repetitive movement.
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What’s more, the children put on the SSRI suffered from a long list of potentially serious side effects. “Citalopram use was significantly more likely to be associated with adverse events, particularly increased energy level, impulsiveness, decreased concentration, hyperactivity, stereotypy (mechanical repetition of the same posture or movement), diarrhea, insomnia and dry skin or pruritis,” the authors write.
“To date, there are few large-scale trials to guide clinical practice, so clinicians are left to address these problems with inadequate information. The results of this trial indicate that citalopram is not an effective treatment for children having autism spectrum disorders with moderate or greater repetitive behavior,” the researchers continue in their Archives of General Psychiatry paper. “The results also highlight the urgent need for placebo-controlled trials of medications commonly used for children with autism spectrum disorders to determine whether the risks of specific drugs substantially outweigh their benefits.”
In other words, they are admitting that commonly used, powerful drugs are widely being given to children with autism — without anyone knowing whether there are any benefits at all, much less whether there are dangerous side effects that could outweigh any potential help from the prescription medications. Citalopram, i.e. Celexa, and the other SSRIs are particularly worrisome because they can spur youngsters to hurt themselves. According to the National Institutes of Health (NIH), “Children, teenagers, and young adults who take antidepressants to treat depression or other mental illnesses may be more likely to become suicidal than children, teenagers, and young adults who do not take antidepressants to treat these conditions.”
Remarkably, although citalopram is widely prescribed for autistic youngsters, the NIH web side states, “However, experts are not sure about how great this risk is and how much it should be considered in deciding whether a child or teenager should take an antidepressant. Children younger than 18 years of age should not normally take citalopram…”