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Citalopram Ineffective for Children with Autism Spectrum Disorders

Repetitive behaviors did not improve with treatment, and activating behaviors increased.

Phenotypic similarities in the repetitive behaviors noted in obsessive-compulsive disorder (OCD) and in autism spectrum disorders (ASDs) have led to the widespread use of SSRIs in children with ASDs. This development has been based largely on controlled studies in adults. Yet, pharmacologically relevant parameters differ in children and adults (JW Psychiatry Apr 14 2008), suggesting the need for child-specific studies.

In a randomized, multisite, 12-week study, 149 children (age range, 5–17 years) with ASDs were randomized to receive liquid citalopram or placebo, with gradual titration to a maximum daily dose of 20 mg. The children had at least moderate levels of repetitive behaviors. Blinded raters used both global-functioning and OCD scales and specifically ascertained adverse effects.

Compliance was excellent, and 83% of participants completed the protocol. At 12 weeks, citalopram and placebo groups showed no significant differences on any measure, except for one that was clinically meaningless. Approximately 33% of children in both groups showed global improvement. Adverse events were significantly more likely to occur with citalopram than with placebo, most commonly increased energy, impulsiveness, decreased concentration, insomnia, diarrhea, hyperactivity, and dry or pruritic skin. Stereotypy was also more frequent in the SSRI group, and five recipients (6.8%) had nightmares (vs. none in the placebo group). Two citalopram recipients had seizures.

Comment: These negative findings weaken the scant data-based rationale for the billions of dollars spent on SSRIs for ASDs. The positive results reported in a study of SSRIs for repetitive behaviors in adult ASDs remain unexplained. High levels of adverse events, including worsening of activating behaviors, add to the caution clinicians should use when considering SSRIs for childhood ASDs.

— Barbara Geller, MD

Published in Journal Watch Psychiatry June 22, 2009

Citation(s):

King BH et al. Lack of efficacy of citalopram in children with autism spectrum disorders and high levels of repetitive behaviors: Citalopram ineffective in children with autism. Arch Gen Psychiatry 2009 Jun; 66:583.

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• Medline abstract (Free)

Volkmar FR. Citalopram treatment in children with autism spectrum disorders and high levels of repetitive behavior. Arch Gen Psychiatry 2009 Jun; 66:581.

• Original article (Subscription may be required)
• Medline abstract (Free)