The selective serotonin reuptake inhibitor (SSRI) antidepressant citalopram
failed to subdue repetitive behaviors in autistic children, a study reported
in the June Archives of General Psychiatry found.
The study, whose lead investigator was Bryan King, M.D., director of
child-adolescent psychiatry at the University of Washington and Seattle
Children's Hospital, was conducted at six academic medical centers and funded
by the National Institutes of Health. It included 149 children aged 5 to 17
who met DSM-IV-TR criteria for autistic disorder, Asperger's
disorder, or pervasive developmental disorder not otherwise
Subjects had an illness-severity rating of at least moderate on the
Clinical Global Impression—Severity of Illness Scale and a score of at
least moderate on compulsive behaviors measured with the Children's Yale-Brown
Obsessive-Compulsive Scales modified for pervasive developmental
Subjects were randomized to receive either citalopram or a placebo for 12
weeks. One reason citalopram was selected over other SSRIs is because it was
available in a liquid formulation, allowing for small dosage adjustments. The
average maximum dosage of citalopram was 16.5 mg a day by mouth (maximum, 20
mg a day).
At the end of the 12 weeks, the researchers compared results for the two
groups. Positive response was defined by a score of much improved or very much
improved on the Clinical Global Impressions—Improvement Subscale. An
important secondary outcome was the score on the Children's Yale-Brown
Obsessive-Compulsive Scales modified for pervasive developmental disorders.
Adverse events were noted using the Safety Monitoring Uniform Report Form.
There was no significant difference in outcome between the two groups.
However, the citalopram group was significantly more likely than the placebo
group to have undesirable effects, especially hyperactivity, impulsiveness,
and sleep problems.
"The medication does not appear to be useful for repetitive behaviors
in children with autism and related conditions," Fred Volkmar, M.D.,
director of the Yale Child Study Center, wrote in an accompanying
Nonetheless, just because citalopram does not appear to be capable of
countering repetitive behaviors in autistic youngsters, that does not
necessarily mean that no SSRI antidepressant can do so, King told
Psychiatric News. Volkmar said that he agreed on this point since
previous double-blind, placebo-controlled studies have shown that SSRIs can
counter repetitive behaviors in autistic adults and since "there can be
differences between SSRIs." King noted, however, that "we can't
assume that other SSRIs prescribed for this indication in this population
would be any better than a placebo if put to a similar test."
Even though results from this trial were negative, it is a good example of
the new, large, well-conducted studies that are being conducted to find
effective treatments for autism, Volkmar pointed out in his editorial. The
reason such studies are now being conducted, he explained, is because more
federal funding has become available for them during the past decade or so
(Psychiatric News, January 4, 2008) due largely to the parents of
autistic children pressuring legislators for it.
Another example of the type of studies that are being conducted in this
arena, he noted, is one that showed that the antipsychotic medication
risperidone can subdue irritability in autistic children (Psychiatric
News, July 15, 2005). This finding, he added, "resulted in the
approval by the U.S. Food and Drug Administration of the use of risperidone
for children with autism that is accompanied by tantrums, aggression, and
An abstract of "Lack of Efficacy of Citalopram in Children
With Autism Spectrum Disorders and High Levels of Repetitive Behavior"
is posted at<http://archpsyc.ama-assn.org/cgi/content/abstract/66/6/583>.▪