Celexa no better than placebo for controlling repetitive behaviors of children with autism, study finds

The Los Angeles Times (6/2, Kaplan) reports that, according to a study published in the June issue of the Archives of General Psychiatry, the antidepressant citalopram, “known as Celexa in the US,” which is “commonly prescribed to help autistic children control their repetitive behaviors, is actually no better than a placebo.” Currently, about a “third of all children diagnosed with autism in the US now take citalopram” or other “closely-related” antidepressants. Now, the “results of the nationwide trial…have some experts reconsidering the appropriateness of antidepressants and other mind-altering” medications “used to treat children with autism spectrum disorders (ASD).” While “only one medication,” the antipsychotic “risperidone has been approved by the Food and Drug Administration for the treatment of irritability and aggression in children with autism,” some “doctors, frustrated by their limited options, haven’t shied away from giving other pharmaceuticals a chance.”

“Citalopram doesn’t reduce repetitive behaviors that are a key characteristic of autism and are a significant reason why this class of antidepressants is prescribed,” the Wall Street Journal (6/2, Wang) explains. Children with ASD “often exhibit repetitive behaviors, including motor symptoms like flapping or rocking, or overly focusing on topics of intense interest. They can be inflexible or become agitated if asked to stop the behaviors.” Selective serotonin reuptake inhibitors (SSRIs) were “thought to be helpful for these symptoms, because they benefit children with obsessive-compulsive disorder, who also exhibit repetitive behaviors.”

For the study, the AP (6/2, Tanner) points out, researchers from the Seattle Children’s Hospital and the University of Washington medical school examined data on “149 autistic children aged five to 17 who were randomly given either up to 20 milligrams daily of Celexa for 12 weeks or dummy pills.” Next, the team “rated children’s symptoms during treatment on a scale of 1 to 7, with high scores reflecting worsening symptoms.” The investigators discovered that “only about one-third of children on Celexa showed substantial improvement; most showed little or no improvement or got worse.” Notably, almost “one-third of children on dummy pills also improved.” The study authors theorized that the improvement could have resulted from the “placebo effect,” or may have “just have been a coincidence, since autism symptoms tend to fluctuate over time.”

Bloomberg News (6/2, Waters) reports that, in a commentary accompanying the study, Fred Volkmar, MD, of the Yale Child Study Center at the Yale University School of Medicine said that “Celexa ‘exhibited significant adverse effects without any evident therapeutic effects in children.” Dr. Volkmar added, “The medication does not appear to be useful for repetitive behaviors in children with autism and related conditions.” During the study, “97 percent of the patients who took Celexa and 87 percent of those who took a placebo had at least one adverse effect,” including “impulsiveness, hyperactivity, decreased concentration and insomnia.” Seven percent of the children taking Celexa also “experienced nightmares.” In his editorial, Dr. Volkmar wrote, “‘Perhaps these data will change this practice” of “prescribing antidepressants for autism.”