Selective serotonin reuptake inhibitors (SSRIs) for autism spectrum disorders

[Guest guest]

I don't post or read here much any more, but this came up on my pubmed feed, and

I thought some here would be interested, or be willing to comment:

Cochrane Database Syst Rev. 2010 Aug 4;8:CD004677.

Selective serotonin reuptake inhibitors (SSRIs) for autism spectrum disorders

(ASD).

K, Wheeler DM, Silove N, Hazell P.

School of Women's and Children's Health, University of New South Wales & Sydney

Children's Hospital, Sydney Children's Community Health Centre, Cnr Avoc &

Barker Street, Randwick, Sydney, NSW, Australia, 2031.

Abstract

BACKGROUND: Autism spectrum disorders (ASD) are characterised by abnormalities

in social interaction and communication skills, as well as stereotypic

behaviours and restricted activities and interests. Selective serotonin reuptake

inhibitors (SSRIs) are prescribed for the treatment of co-morbidity associated

with ASD such as depression, anxiety and obsessive-compulsive behaviours.

OBJECTIVES: To determine if treatment with an SSRI: 1. improves the core

features of autism (social interaction, communication and behavioural problems);

2. improves other non-core aspects of behaviour or function such as

self-injurious behaviour; 3. improves the quality of life of children and their

carers; 4. has short and long term effects on outcome; 5. causes harms. SEARCH

STRATEGY: We searched the Cochrane Central Register of Controlled Trials (The

Cochrane Library 2009, Issue 4), MEDLINE ( December 2009), EMBASE (December

2009), CINAHL (December 2009), PsycINFO (December 2009) and ERIC (December

2009), without language restrictions. SELECTION CRITERIA: Randomised controlled

trials (RCTs) of any dose of oral SSRI compared with placebo, in participants

with autism spectrum disorders. Trials must have included at least one

standardised outcome measure. DATA COLLECTION AND ANALYSIS: Two authors

independently selected and appraised studies for inclusion and risk of bias. All

data were continuous. Meta-analysis, where possible, used a random-effects

model. MAIN RESULTS: Seven RCTs with a total of 271 participants were included.

Four SSRIs were evaluated: fluoxetine (two studies), fluvoxamine (two studies),

fenfluramine (two studies) and citalopram (one study). Five studies included

only children and two studies included only adults. Varying inclusion criteria

were used with regard to diagnostic criteria and intelligence of participants.

Seventeen different outcome measures were reported. Although more than one study

reported data for Clinical Global Impression (CGI) and obsessive-compulsive

behaviour (OCB), different tool types or components of these outcomes were used

in each study. As such, data were unsuitable for meta-analysis. One large, high

quality study in children showed no evidence of positive effect of citalopram.

Two small studies in adults showed positive outcomes for CGI and OCB; one study

showed improvements in aggression and another in anxiety. AUTHORS' CONCLUSIONS:

There is no evidence of effect of SSRIs in children and emerging evidence of

harm. There is limited evidence of the effectiveness of SSRIs in adults from

small studies in which risk of bias is unclear.

PMID: 20687077 [PubMed - in process]

[Guest guest]

I am very concerned about this as well. My son takes a small dose of Lexapro

and has been doing well but I worry about the long term effects...

From: [mailto: ] On Behalf Of

jennifer_bardwell

Sent: August-07-10 9:46 AM

Subject: Selective serotonin reuptake inhibitors (SSRIs) for autism

spectrum disorders

I don't post or read here much any more, but this came up on my pubmed feed,

and I thought some here would be interested, or be willing to comment:

Cochrane Database Syst Rev. 2010 Aug 4;8:CD004677.

Selective serotonin reuptake inhibitors (SSRIs) for autism spectrum

disorders (ASD).

K, Wheeler DM, Silove N, Hazell P.

School of Women's and Children's Health, University of New South Wales &

Sydney Children's Hospital, Sydney Children's Community Health Centre, Cnr

Avoc & Barker Street, Randwick, Sydney, NSW, Australia, 2031.

Abstract

BACKGROUND: Autism spectrum disorders (ASD) are characterised by

abnormalities in social interaction and communication skills, as well as

stereotypic behaviours and restricted activities and interests. Selective

serotonin reuptake inhibitors (SSRIs) are prescribed for the treatment of

co-morbidity associated with ASD such as depression, anxiety and

obsessive-compulsive behaviours. OBJECTIVES: To determine if treatment with

an SSRI: 1. improves the core features of autism (social interaction,

communication and behavioural problems); 2. improves other non-core aspects

of behaviour or function such as self-injurious behaviour; 3. improves the

quality of life of children and their carers; 4. has short and long term

effects on outcome; 5. causes harms. SEARCH STRATEGY: We searched the

Cochrane Central Register of Controlled Trials (The Cochrane Library 2009,

Issue 4), MEDLINE ( December 2009), EMBASE (December 2009), CINAHL (December

2009), PsycINFO (December 2009) and ERIC (December 2009), without language

restrictions. SELECTION CRITERIA: Randomised controlled trials (RCTs) of any

dose of oral SSRI compared with placebo, in participants with autism

spectrum disorders. Trials must have included at least one standardised

outcome measure. DATA COLLECTION AND ANALYSIS: Two authors independently

selected and appraised studies for inclusion and risk of bias. All data were

continuous. Meta-analysis, where possible, used a random-effects model. MAIN

RESULTS: Seven RCTs with a total of 271 participants were included. Four

SSRIs were evaluated: fluoxetine (two studies), fluvoxamine (two studies),

fenfluramine (two studies) and citalopram (one study). Five studies included

only children and two studies included only adults. Varying inclusion

criteria were used with regard to diagnostic criteria and intelligence of

participants. Seventeen different outcome measures were reported. Although

more than one study reported data for Clinical Global Impression (CGI) and

obsessive-compulsive behaviour (OCB), different tool types or components of

these outcomes were used in each study. As such, data were unsuitable for

meta-analysis. One large, high quality study in children showed no evidence

of positive effect of citalopram. Two small studies in adults showed

positive outcomes for CGI and OCB; one study showed improvements in

aggression and another in anxiety. AUTHORS' CONCLUSIONS: There is no

evidence of effect of SSRIs in children and emerging evidence of harm. There

is limited evidence of the effectiveness of SSRIs in adults from small

studies in which risk of bias is unclear.

PMID: 20687077 [PubMed - in process]