Dr Ananya Mandal, MD

According to a thorough review published by Cochrane Researchers, commonly prescribed antidepressant drugs cannot be recommended for those suffering from autistic spectrum disorders based on current evidence. They say that there may be benefits of antidepressants in adults diagnosed with autism but similar benefits are not seen in children. These children may suffer extremely adverse effects if they consume selective serotonin reuptake inhibitors (SSRIs).

Autistic spectrum disorders show a range of symptoms including difficulties with social interactions and communication of all types. These SSRIs are the most commonly prescribed drugs despite the fact that none of these have been approved by any drug authority for their use in autism.

For the study the researchers included a total of seven trials, involving 271 patients. The trials evaluated fluoxetine, fluvoxamine, fenfluramine and Citalopram – all SSRIs. Overall, the researchers found no benefit in the five trials in children and some evidence of serious harm, including one child who suffered a prolonged seizure after taking citalopram. The two trials in adults were very small and thus, although there was some evidence for improvement in symptoms, the authors concluded there was too little evidence for the drugs to be recommended.

Lead author Katrina Williams of the University of New South Wales says, “We can’t recommend SSRIs as treatments for children, or adults, with autism at this time. However, decisions about the use of SSRIs for co-occurring obsessive-compulsive disorder, aggression, anxiety or depression in individuals with autism should be made on a case by case basis… Not all the SSRIs currently in use have undergone controlled trials for autistic spectrum disorders, but parents are often anxious to try treatments regardless of the lack of evidence…It’s important that doctors are open about the lack of evidence, and explain any risks fully, before prescribing these treatments.”

Most of the antidepressants are not approved for children for any condition in the UK. The research was funded by the Children Hospital at Westmead, Financial Markets Foundation for Children and the Australian Department of Health and Aging. It has been published in the latest issue of the ‘Cochrane Database of Systematic Reviews’ under the title ‘Selective serotonin re-uptake inhibitors (SSRIs) for autism spectrum disorders.’