August 26, 2009
By David Gutierrez
The antidepressant Celexa, commonly prescribed to alleviate some symptoms of autism in children, has no medical benefit in such patients, while exposing them to a significant risk of side effects.
Researchers treated 149 autistic children between the ages of five and 17 with either Celexa (generic name citalopram) or a placebo for 12 weeks. While one third of the patients who took Celexa showed improvement in symptoms over the study period, just as many patients showed improvement on the placebo. Children who took Celexa were twice as likely to suffer from side effects, including insomnia and impulsiveness, as children who took a placebo.
Lead researcher Bryan King noted that doctors prescribing drugs for “off-label” uses not approved by the FDA — often uses for which few studies of effectiveness or safety have been done — may think the treatment is actually working because of strong placebo effects like that seen in this study.
Celexa is an antidepressant in the selective serotonin reuptake inhibitor (SSRI) class. Because many SSRIs have shown some effectiveness in treating the symptoms of obsessive compulsive disorder in adults, growing numbers of pediatricians are turning to the drugs to treat obsessive, repetitive behaviors in autistic children. Many autistic children are prone to carry out repetitive behaviors like counting or arm flapping almost uncontrollably, often flying into a tantrum if interrupted.
The only drug approved by the FDA to treat irritability and aggression in autistic children is the atypical antipsychotic risperidone. Federal law allows doctors to prescribe drugs for any use they wish, however.
Treatment of obsessive symptoms in autistic children with Celexa or other SSRIs has been premised on the untested assumption that such symptoms stem from similar neurological pathways as those of adult obsessive compulsive disorder. The new study has cast serious doubt onto that hypothesis.