Drug Fails To Benefit Autistic Kids   

By Shirley S. Wang
The Wall Street Journal
6/2/2009
427 words

Kids with autism don't benefit from treatment with the popularly prescribed antidepressant citalopram, according to a large, government-funded trial of children with autism and related conditions.

The study, published Monday in the Archives of General Psychiatry, is the first to show that citalopram doesn't reduce repetitive behaviors that are a key characteristic of autism and are a significant reason why this class of antidepressants is prescribed.

Children with autism-spectrum disorders often exhibit repetitive behaviors, including motor symptoms like flapping or rocking, or overly focusing on topics of intense interest. They can be inflexible or become agitated if asked to stop the behaviors.

Antidepressants known as selective serotonin reuptake inhibitors, or SSRIs, are thought to be helpful for these symptoms because they benefit children with obsessive-compulsive disorder, who also exhibit repetitive behaviors. But the effectiveness of antidepressants for children with autism hadn't been well-studied.

In the new study, 149 children with autism and related disorders were randomized to be treated with either citalopram or a placebo for 12 weeks. At the end of the period, those who received citalopram, which is sold by a number of generic makers and under the brand name Celexa by Forest Laboratories Inc., were no better than those in the placebo group in terms of their general functioning or in their repetitive behaviors, the study found.

Both groups showed a "placebo-like response" of about 30%, said Lawrence Scahill, a study author and professor of child psychiatry and nursing at the Child Study Center at Yale University. More than 50% of kids should improve significantly with a good treatment, he said.

"Clinicians should be very careful about what they're targeting if they're using medications," said Dr. Scahill. Such medicines may be useful in these children to treat depression or anxiety, as they are in kids without autism, but "if you're targeting for repetitive behaviors, this medication does not appear to be effective," he said.

While some individual children might respond to the medication, overall, "I do think the results from this study don't encourage the use of this medication for repetitive behaviors in autism," said Thomas Insel, director of the National Institutes of Mental Health, who wasn't involved in the study.

"It's disappointing," said Dr. Insel of the results. "We have behavioral interventions but we're still lacking very effective medical interventions for the large majority of children with these problems."

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