What Else Doesn't Work in Autism

Citalopram (Celexa; Forest), the model SSRI, is no better than placebo for improving general behavior and reducing repetitive behaviors in children with autism or related disorders.* This conclusion is based on a multicenter, NIH-sponsored 12-week trial of the antidepressant in 149 pediatric volunteers (age range, 5-17 years; mean age, 9.4 years) with at least moderate disease. Results of the study were published in the June issue of the Archives of General Psychiatry.

Rates of general improvement (measured with the Clinical Global Impressions, Improvement subscale) were similar with citalopram (32.9%) and placebo (34.2%), and scores for OCD-like behaviors were similarly reduced with either treatment. Adverse event data suggest that citalopram is more likely to be associated with undesirable behaviors—like impulsiveness, decreased concentration, hyperactivity, stereotypy, and insomnia.

The mean dosage of citalopram administered in the study was 16.5 mg/d, with a maximum dosage of 20 mg/d. (The initial starting dosage in adults is 20 mg/d, which is typically increased to a maintenance dosage of 40 mg/d.) Citalopram has not been FDA approved for use in the pediatric population, and the label includes the general "black box" for SSRIs, which warns of suicide risk in minors.

NIH = National Institutes of Health; OCD = obsessive-compulsive disorder; SSRI = selective serotonin-reuptake inhibitor.

* Including Asperger disorder and unspecified pervasive development disorder.