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Los Angeles Times
By Karen Kaplan
Tuesday, June 2, 2009 at 12:00 AM
An antidepressant commonly prescribed to help autistic children control their repetitive behaviors is no better than a placebo, according to a report published Monday. It also caused nightmares and other side effects, the research found.
Roughly one-third of all children with autism take citalopram, the antidepressant examined in the study, or others that are closely related.
The results of the nationwide trial, published in Archives of General Psychiatry, have some experts reconsidering the appropriateness of not just antidepressants but many of the mind-altering drugs used to treat kids with autism spectrum disorders.
About 1.5 million Americans are estimated to have autism, a group of poorly understood developmental disorders characterized by problems with communication and social interactions. One of the hallmarks is obsessive, repetitive behavior, such as flapping one’s arms or hands or memorizing car makes and models. When those routines are interrupted, severe tantrums can result.
Only one medication — the antipsychotic drug risperidone — has been approved by the U.S. Food and Drug Administration for the treatment of irritability and aggression in children with autism.
But doctors, frustrated by their limited options, haven’t shied away from giving other pharmaceuticals a chance. Worldwide spending on drugs to treat autism is estimated to be $2.2 billion to $3.5 billion annually.
Because few medications have been tested on autistic children in large, rigorous studies, doctors have looked to drugs that treat similar symptoms in other conditions, such as obsessive-compulsive disorder or attention-deficit hyperactivity disorder.
That’s what led physicians to a class of antidepressants called selective serotonin re-uptake inhibitors, or SSRIs, that help adults with obsessive-compulsive disorder. Their repetitive rituals, such as counting, cleaning or hand-washing, are reminiscent of the behaviors seen in autistic patients.
Doctors were also hopeful because the serotonin system is known to function improperly in people with autism.
But the medications will work only if the root causes of obsessive-compulsive disorder and autistic repetitive behavior involve the same biological pathways in the brain. The new study strongly suggests they do not.
“It just begs for a more careful understanding of the neurological underpinnings of the disorder,” Mandell said.
Dr. Bryan King, director of psychiatry and behavioral medicine at Seattle Children’s Hospital and leader of the study, said he was shocked citalopram didn’t help patients.
Not only was the placebo slightly more effective, but the drug’s side effects — such as impulsivity and insomnia — – were at least twice as bad.
Citalopram is sold in the United States under the brand name Celexa.