SSRIs Not Recommended for Autism in Children or Adults Based on Current Evidence

From MedscapeCME Clinical Briefs

News Author: Pauline Anderson
CME Author: Charles P. Vega, MD

CME/CE Released: 08/17/2010;

Clinical Context

Estimates of the prevalence of ASD vary from study to study, according to the authors of the current systematic review. However, it appears that these estimates have been increasing during the last several years, with rates as high as 116 per 10,000 individuals.
ASD affects boys approximately 4 times more often than girls, and symptoms of ASD usually begin in early childhood.
ASD promotes chronic disability for many patients;
only 3% to 10% of adults with autism are able to live independently.

SSRIs are the most frequently prescribed psychotropic medications for patients with ASD, and they may help to reduce anxiety and obsessive-compulsive symptoms common to ASD.
The current systematic review examines the efficacy and safety of SSRI treatment among patients with ASD.

Study Highlights

•Researchers examined randomized, placebo-controlled trials of SSRIs for patients with ASD. Study outcomes could include core features of ASD or other aspects of behavior, function, or quality of life.
•Included studies were published before December 2009.
•46 studies were found on the original search. These titles were pared to 5 studies of children and 2 studies of adults for the final data analysis. The total number of patients in these 7 studies was 271.
•The 5 studies of children included participants between the ages of 3 and 17 years. These protocols tested fenfluramine, fluoxetine, fluvoxamine, and citalopram. 2 studies focused exclusively on children with autism and intellectual impairment, and the others included children with ASD.
•None of the included research in children suggested that SSRIs could significantly improve core features of ASD in this population. Likewise, SSRIs did not appear to significantly reduce the clinical global impression or obsessive-compulsive symptoms.
•There were only minor improvements in children's behavior with SSRIs vs placebo.
•Citalopram was associated with a higher rate of adverse events vs placebo among children. In 1 child, prolonged seizures developed from use of citalopram. However, in another study, fluoxetine was not associated with a higher rate of adverse events vs placebo among children.
•Among adults, a study of 30 patients focused on fluvoxamine, and another study examined fluoxetine among 6 patients.
•There was some suggestion of global clinical improvement with SSRIs vs placebo in adults. Fluoxetine improved a measure of anxiety, but not depression. Fluvoxamine improved a measure of aggression.
•Fluvoxamine was associated with a significant improvement in obsessive-compulsive behaviors vs placebo, whereas fluoxetine was not.
•SSRIs were not associated with significant adverse events among adults.
•The reviewers conclude that SSRIs appear not to be beneficial and, in fact, may be harmful to children with ASD. Small studies among adults with ASD have indicated some efficacy and better tolerability of SSRI.

Clinical Implications

•The prevalence of ASD appears to have increased during the last several years. ASD affects boys approximately 4 times more often than girls, and symptoms of ASD usually begin in early childhood. Only 3% to 10% of adults with autism are able to live independently.
•The current systematic review finds that SSRIs are not helpful for children with ASD but may have more efficacy among adults with ASD.