Citalopram, a medication commonly prescribed to children with autism spectrum disorders (ASD),
was no more effective than a placebo at reducing repetitive behaviors,
according to researchers funded by the National Institute of Mental
Health (NIMH) and other NIH institutes. The study was published in the
June 2009 issue of Archives of General Psychiatry.
"Parents
of children with autism spectrum disorders face an enormous number of
treatment options, not all of which are research-based," said NIMH
Director Thomas R. Insel, M.D. "Studies like this help us to better
understand which treatments are likely to be beneficial and safe."
The
researchers say their findings do not support using citalopram to treat
repetitive behaviors in children with ASD. Also, the greater frequency
of side effects from this particular medication compared to placebo
illustrates the importance of placebo-controlled trials in evaluating
medications currently prescribed to this population.
Citalopram
is in a class of antidepressant medications called selective serotonin
reuptake inhibitors (SSRIs) that is sometimes prescribed for children
with ASD to reduce repetitive behaviors. These behaviors, a hallmark of
ASD, include stereotypical hand flapping, repetitive complex whole body
movements (such as spinning, swaying, or rocking over and over, with no
clear purpose), repetitive play, and inflexible daily routines.
Past
research suggested that some children with ASD have abnormalities in
the brain system that makes serotonin, a brain chemical that, among
many other functions, plays an important role in early brain
development. Children with obsessive compulsive disorder (OCD)
may also have serotonin abnormalities and have repetitive or inflexible
behaviors. OCD is effectively treated with SSRIs, leading some
researchers to wonder whether similar treatment may reduce repetitive
behaviors in children with ASD. So far, studies have produced mixed
results, but SSRIs remain among the most frequently prescribed
medications for children with ASD.
Researchers in the Studies to Advance Autism Research and Treatment (STAART)
network, funded by five NIH institutes, conducted a six-site,
randomized controlled trial comparing the effectiveness and safety of
using the SSRI citalopram (Celexa) versus placebo to treat repetitive
behaviors in children with ASD. The study included 149 participants,
ages 5–17, who had autism, Asperger disorder, or pervasive
developmental disorder-not otherwise specified (PDD-NOS).
After
12 weeks of treatment, roughly 1 out of 3 children in both groups—32.9
percent of those treated with citalopram and 34.2 percent those treated
with placebo—showed fewer or less severe repetitive symptoms.
"Adverse
symptoms were common in both groups, probably reflecting common
childhood ailments as well as the changing nature of symptoms
associated with ASD," according to Bryan King, M.D., director of child
and adolescent psychiatry at Seattle Children's Hospital and lead
author on the study. "However, reports of increased energy,
impulsiveness, decreased concentration, hyperactivity, diarrhea,
insomnia, and dry skin were more common in the citalopram group."
According
to the researchers, the study results may challenge the underlying
premise that repetitive behaviors in children with ASD are similar to
repetitive and inflexible behaviors in OCD.
The authors on the
paper include Bryan H. King, M.D., Seattle Children's Hospital; Eric
Hollander, M.D., Mount Sinai School of Medicine; Linmarie Sikich, M.D.,
University of North Carolina, Chapel Hill; James T. McCracken, M.D.,
University of California Los Angeles; Lawrence Scahill, M.S.N., Ph.D.,
Yale University; Joel D. Bregman, M.D., North Shore Long Island Jewish
Health System; Craig L. Donnelly, M.D., Dartmouth Medical School;
Evdokia Anagnostou, M.D., Mount Sinai School of Medicine (currently at
the University of Toronto); Kimberly Dukes, Ph.D., DM-STAT; Lisa
Sullivan, Ph.D., Boston University; Deborah Hirtz, M.D., National
Institute of Neurological Disorders and Stroke (NINDS); Ann Wagner,
Ph.D., NIMH; Louise Ritz, M.B.A., NIMH (currently at NINDS); and the
STAART Psychopharmacology Network.
Additional Sources of
Information:
Great Informational Websites Created by Dr. Speller and Dr. Korkosz:
Sources: National Institute of Mental Health, See also blogposts in Psychiatric Disorders: General, Depression, and Autism Spectrum Disorders
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Dr. Jeffrey SpellerDr. Tanya Korkosz
Psychopharmacology Associates of New England
www.psychopharmassociates.com
