Autism Drug Citalopram Is Ineffective, Says Study

A drug commonly given to autistic children to reduce repetitive behaviors is ineffective compared to placebo and, in some children, may actually increase repetitive behaviors, the largest study of autistic children to date has found.

“What we found, much to our surprise, is that there was no significant difference in positive response between kids treated with citalopram and kids who received the placebo. And the kids treated with citalopram tended to have more side effects,” said Linmarie Sikich, M.D., a co-author of the study and associate professor of psychiatry in the University of North Carolina at Chapel Hill School of Medicine.

“I cannot emphasize this enough: This was not at all what we expected to see,” Sikich said.

Results of the study, a randomized controlled clinical trial of the drug citalopram, are published in the June 29, 2009 issue of Archives of General Psychiatry. It was funded by the National Institutes of Health and took place at six academic medical centers across the country. Principal investigator and lead author of the study is Bryan H. King, M.D., who began the study at Dartmouth and continued to oversee it there after he moved to the University of Washington, where he is currently director of psychiatry and behavioral medicine at Seattle Children’s Hospital.

Citalopram, which is sold under the brand name Celexa, is one of a class of antidepressant drugs called selective serotonin reuptake inhibitors, or SSRIs. SSRIs are the most frequently used medications for children with autism. They are also used to treat depression, anxiety and obsessive compulsive disorder in both adults and children. Prior to this study there was very little scientific evidence to support the use of SSRIs in autistic children, but some preliminary studies showed promising results for citalopram, Sikich said.

Hypothesizing that citalopram would improve the overall functioning of autistic children and adolescents by reducing repetitive behavior, Sikich and colleagues recruited 149 children ages 5 to 17 to take part in the 12-week trial. Seventy-three received daily doses of liquid citalopram while 76 received daily doses of liquid placebo. Researchers measured the children’s’ response to treatment using the Clinical Global Impression-Improvement scale (CGI-I). They also recorded measures of repetitive behavior and side effects.

At the end of the trial, some children in both groups showed a positive response. However, there was no significant difference between the groups: the positive response in the citalopram group was 32.9 percent versus 34.2 percent in the placebo group. In addition, children in the citalopram group were significantly more likely to experience adverse side effects such as increased energy level, impulsiveness, decreased concentration, hyperactivity, increased repetitive movements and behaviors, diarrhea, insomnia, and dry itchy skin.

The researchers concluded that citalopram “is not an effective treatment” for autistic children with repetitive behaviors. In addition, they wrote, this trial shows that the use of SSRIs in autistic children “is not without risk” and “at present there is insufficient research evidence to merit a clear recommendation regarding the use of SSRIs as a class” for the treatment of repetitive behavior in children with autism spectrum disorders.

“The obvious short term message is, this treatment didn’t work. And that surprised us a great deal,” Sikich says. “But the really important take-home message is that we have to do large, scientifically-sound comparative studies like this to really know whether a specific treatment works and is safe. Simply relying on doctors’ and families’ impressions often leads us to use medications that really don’t work and may do more harm than good” says Sikich.

Safe and effective medication and behavioral treatments are desperately needed to help children with autism realize their potentials and keep from harming themselves or others, Sickish says.

“Well-done studies, using methods like the ones in this study, have shown that another drug, risperidone, is useful in reducing irritability and aggression in children with autism,” she says. “Thus, this study shouldn’t be interpreted as saying all medications don’t help people with autism and are harmful. Instead it says that citalopram doesn’t help most children with autism and is harmful to some children. Clearly we need more research to develop and test other interventions for this important problem.”

People with autism are severely impaired by the disorder and experience major problems with highly repetitive behaviors, often including self-injurious behaviors, communicating and interacting appropriately with others. Frequently the repetitive behaviors keep children with autism from learning in school or participating in age appropriate activities. When it is time to stop the repetitive behavior and begin a new, functional activity, many children with autism become distraught and aggressive. These repetitive behaviors also contribute to the difficulties that make it hard for most people with autism to live independently or work as adults, Sikich says.

In addition to UNC, academic medical centers taking part in the study were Mt. Sinai School of Medicine, North Shore-Long Island Jewish Health System, Dartmouth, UCLA and Yale University.

The study was conducted as part of the NIH-sponsored Studies to Advance Autism Research and Treatment network.

Source: University of North Carolina at Chapel Hill School of Medicine , May 28, 2009

Comments

  1. quiact says

    Thoughts Regarding Autism Spectrum Neurodevelopmental Disorders

    Of these rare neurological disorders, Autism is the most common. The autism spectrum reflects the broad range of symptoms in which the names of these autism disorders have been given their own name for their disorder.

    Autism is a disability that is suspected to be caused possibly by a brain development disorder of unknown etiology. Others suspect the cause is some sort of neurological dysfunction- possibly with a genetic predisposition. Autism is about 3 times more common in males than females as well, and it is unclear as to why this occurs.

    Usually, symptoms of the disease present themselves before the toddler reaches the age of three. Before Autism was more understood, others inaccurately labeled autistic people as childhood schizophrenia or as having a psychosis or mental retardation.

    Symptoms of the autistic patient included limited or dysfunctional social and personal or intimate relationships with others, their intelligence is affected, and the autistic person typically is adverse to change. Also, the autistic person tends to be compulsive and prefers to be alone. They lack eye contact as much as physical contact with other people.

    Out of over two dozen diagnostic criteria utilized for these disorders, eight must be present to be considered autistic, according to the DSM. As with all passive developmental disorders, the person expresses language, social, and behavioral difficulties.

    Treatment includes what are called psychotropic medications that delay the progression of the disorder, as well as relieve some of the symptoms of one who is autistic. Behavioral therapy is common as a treatment regimen as well. Boys get Autism much more than girls.

    Then there is the controversy between many who claim that thimerosal- a preservative containing mercury, which is a neurotoxin that was used in vaccines until 2001, was the catalyst for autism in children.
    Over 5000 lawsuits have been filed because of this belief, and some have been successful for the plaintiff. Yet most agree the correlation between thimersal and autism is void of scientific merit. Furthermore, the cases of autism have not decreased since the preservative was discontinued in 2001.

    Aside from Autism, the other four passive developmental disorders are known as autism spectrum disorders.

    Asperger’s Syndrome is more common than autism, and the symptoms are milder, as there is minimal delay in language abilities, if at all. What is expressed with Asperger’s syndrome is mild autistic symptoms. In time, the patient may express atypical personality disorders, though.

    While intelligence is within normal limits with the Asperger’s patient, social interactions and abilities preset difficulty for such a patient. As with Autism, medications and behavioral therapy are treatment regimens with one with this syndrome.

    Rett’s Syndrome or disorder presents with not only atypical behavior, but also suffers from restricted physical growth and movement. There is cognitive and social impairment as well. The disorder affects mostly girls, and the cause is due to a gene mutation.

    Childhood Disintegrative disorder is rare, and is 10 times less common than autism. The disorder has a late onset with mild autistic symptoms. The disorder affects mostly boys, and regression is sudden and possible with this disorder.

    Skills lost with this disorder may be language, social, self-care, as well as play or motor skills. Decreased function or impairment with this disorder may include social skills and behavioral flaws. Central Nervous System pathology is a suspected cause of this disorder.

    Finally, there are passive development disorders that are not otherwise specified. This may include atypical autism, for example. Yet as with the rest of types of these disorders, the symptoms vary in their frequency and intensity, as well as the range of abilities of these developmental disorders vary widely as well.
    Medicinal treatment is believed to be not necessary for the management of all of those who may have autistic spectrum disorders.

    Depending on the patient’s health care provider, medications may be prescribed by their doctor to manage any affective disorders autistics may present in an acute or chronic nature. However, cognitive and behavioral therapy prove to be most beneficial for all the different types of Passive Development Disorders that exist for reasons yet to be defined.

    http://www.autism-society.org

    Dan Abshear

  2. quiact says

    Thoughts Regarding Autism Spectrum Neurodevelopmental Disorders

    Of these rare neurological disorders, Autism is the most common. The autism spectrum reflects the broad range of symptoms in which the names of these autism disorders have been given their own name for their disorder.

    Autism is a disability that is suspected to be caused possibly by a brain development disorder of unknown etiology. Others suspect the cause is some sort of neurological dysfunction- possibly with a genetic predisposition. Autism is about 3 times more common in males than females as well, and it is unclear as to why this occurs.

    Usually, symptoms of the disease present themselves before the toddler reaches the age of three. Before Autism was more understood, others inaccurately labeled autistic people as childhood schizophrenia or as having a psychosis or mental retardation.

    Symptoms of the autistic patient included limited or dysfunctional social and personal or intimate relationships with others, their intelligence is affected, and the autistic person typically is adverse to change. Also, the autistic person tends to be compulsive and prefers to be alone. They lack eye contact as much as physical contact with other people.

    Out of over two dozen diagnostic criteria utilized for these disorders, eight must be present to be considered autistic, according to the DSM. As with all passive developmental disorders, the person expresses language, social, and behavioral difficulties.

    Treatment includes what are called psychotropic medications that delay the progression of the disorder, as well as relieve some of the symptoms of one who is autistic. Behavioral therapy is common as a treatment regimen as well. Boys get Autism much more than girls.

    Then there is the controversy between many who claim that thimerosal- a preservative containing mercury, which is a neurotoxin that was used in vaccines until 2001, was the catalyst for autism in children.
    Over 5000 lawsuits have been filed because of this belief, and some have been successful for the plaintiff. Yet most agree the correlation between thimersal and autism is void of scientific merit. Furthermore, the cases of autism have not decreased since the preservative was discontinued in 2001.

    Aside from Autism, the other four passive developmental disorders are known as autism spectrum disorders.

    Asperger’s Syndrome is more common than autism, and the symptoms are milder, as there is minimal delay in language abilities, if at all. What is expressed with Asperger’s syndrome is mild autistic symptoms. In time, the patient may express atypical personality disorders, though.

    While intelligence is within normal limits with the Asperger’s patient, social interactions and abilities preset difficulty for such a patient. As with Autism, medications and behavioral therapy are treatment regimens with one with this syndrome.

    Rett’s Syndrome or disorder presents with not only atypical behavior, but also suffers from restricted physical growth and movement. There is cognitive and social impairment as well. The disorder affects mostly girls, and the cause is due to a gene mutation.

    Childhood Disintegrative disorder is rare, and is 10 times less common than autism. The disorder has a late onset with mild autistic symptoms. The disorder affects mostly boys, and regression is sudden and possible with this disorder.

    Skills lost with this disorder may be language, social, self-care, as well as play or motor skills. Decreased function or impairment with this disorder may include social skills and behavioral flaws. Central Nervous System pathology is a suspected cause of this disorder.

    Finally, there are passive development disorders that are not otherwise specified. This may include atypical autism, for example. Yet as with the rest of types of these disorders, the symptoms vary in their frequency and intensity, as well as the range of abilities of these developmental disorders vary widely as well.
    Medicinal treatment is believed to be not necessary for the management of all of those who may have autistic spectrum disorders.

    Depending on the patient’s health care provider, medications may be prescribed by their doctor to manage any affective disorders autistics may present in an acute or chronic nature. However, cognitive and behavioral therapy prove to be most beneficial for all the different types of Passive Development Disorders that exist for reasons yet to be defined.

    http://www.autism-society.org

    Dan Abshear

  3. autismdepakoterisk says

    Warning: autistic children taking depakote (common mood stabilzer or seizure drug) or valporic acid are at high risk for hyperammonia which can worsen autistic behaviors like self-injury or aggression. Google depakote and hyperammonia. Abbott pharmaceuticals sent out warning letters regarding this and few neurologists or psychiatristis even check for hyperammonia

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