Based on current evidence, the commonly practiced therapy of prescribing antidepressants to people with autistic spectrum disorders cannot be recommended, according to a new study by Cochrane researchers. Even though some evidence exists of benefits to a number of adults with autism, there is no proof of any benefits associated with selective serotonin reuptake inhibitors (SSRIs) in children, who may suffer serious undesirable side effects from taking the medications.

Because of the range of symptoms associated with autistic spectrum disorders, including difficulties with social interactions and communication, they are hard to treat. Although no SSRIs have been specifically approved by any drug authority for autism treatment, they are commonly prescribed medications.

In Great Britain the majority of antidepressants are not approved for any childhood condition.

The justification for SSRI use among people with autism is that they act on serotonin, the same chemical in the body that is responsible for some of the psychological processes affected by the condition.

The scientists examined seven different trials, involving 271 individuals which evaluated fluoxetine, fluvoxamine, fenfluramine and citalopram, in this latest study. On the whole, they 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 therefore, although there was some evidence for improvement in symptoms, the authors concluded there was too little evidence for the drugs to be recommended. A major problem with analyzing the results was that all the trials used different measures for assessing the drugs’ effects.

Lead author Katrina Williams of the School of Women’s and Children’s Health at the University of New South Wales & Sydney Children’s Hospital in Sydney, Australia, said:

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.

“Selective serotonin reuptake inhibitors (SSRIs) for autism spectrum disorders (ASD)”
Williams K, Wheeler DM, Silove N, Hazell P.
Cochrane Database of Systematic Reviews 2010, Issue 8. Art. No.: CD004677.
DOI: 10.1002/14651858.CD004677.pub2.

Written by Christian Nordqvist