Autism and Medication Part 2 – SSRIs

medicineSSRIs are a type of medication generally used to treat depression and anxiety disorders. They work by blocking the reabsorption of the neurotransmitter serotonin in the brain. Increasing serotonin in the brain helps brain cells send and receive chemical messages, which results in better moods for the patient. Common SSRIs include Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetine (Prozac), Paroxetine (Paxil, Pexeva), and Sertaline (Zoloft).

SSRIs are used to treat a variety of autism symptoms, including anxiety, depression, and repetitive, obsessive behaviors. A 2011 study by Eric Hollander, M.D., Albert Einstein College of Medicine and Montefiore Medical Center in Bronx, New York, found that Prozac decreased repetitive behaviors in autistic adults. Thirty-seven adults with autism were given either Prozac or a placebo over a 12 week period. The results showed that 50% of the participants in the Prozac group demonstrated a significant decrease in repetitive behaviors, compared to 8% of the placebo group.

But are they effective for children?

A review of five published studies on the effectiveness of SSRIs to treat repetitive behaviors in children with autism found that they reduced behaviors by approximately 22%. However, the researchers found five additional studies that had not been published, and found that when the unpublished studies were included, the effectiveness of the drug dropped to approximately 12%.

Why would unpublished studies create such a significant difference?

One theory is that many journals are reluctant to publish studies that show that a medication or treatment doesn’t work. Melissa Carrasco, PhD and recent graduate of the neuroscience program at the University of Michigan in Ann Arbor, says,

“It definitely brings up a huge problem in this field. There’s really no umbrella organization that’s overseeing that everybody who gets funding to do these studies, that they go ahead and then report it publicly. This is not rigorously enforced. It makes you wonder if the reason why they didn’t get published is because they had negative results.”

Parents who have tried SSRIs report various results. A parent known as “Noah’s Mom” on the Health Boards Message Boards says,

“Through the last year we have seen very positive changes. Noah has been in therapy for a year now, and is making eye contact, being less withdrawn, and beginning to speak.”

Another parent named Heather posted the following on the Popsugar Circle of Moms message board,

“My son has Aspergers and his doctor has put him on Prozac. He has been on it now for about two weeks. All of a sudden my son loses control in the afternoon. . . Last week he ran from the classroom went into the kitchen and started destroying things.”

Side effects of SSRIs may include nausea, nervousness, agitation, dizziness, reduced sexual desire, drowsiness, insomnia, weight gain or loss, headache, dry mouth, vomiting and diarrhea. Other studies have suggested that SSRIs may increase thoughts of suicide in adolescents and young adults.

Parents who are considering SSRIs for their children should consult with their doctor to weigh the risks with the possible benefits.

Our next article, part 3 continues tomorrow and will focus on antipsychotic medications.