EBD Blog

Citalopram, one of the class of drugs known as selective serotonin reuptake inhibitors (SSRIs) which are usually used to address depression, did not yield beneficial results in a recent study of whether the use of the drug with children and youth with Autism reduced repetitive behaviors. The study, reported by Bryan King and colleagues, included 149 individuals ages 5 through 17 with moderate or severe Autism who were recruited from various parts of the US. Not only did the treated group appear no better than the placebo group, but the children in the Citalopram group were more likely to have adverse outcomes.

Lack of Efficacy of Citalopram in Children With Autism Spectrum Disorders and High Levels of Repetitive Behavior Citalopram Ineffective in Children With Autism

Bryan H. King, MD; Eric Hollander, MD; Linmarie Sikich, MD; James T. McCracken, MD; Lawrence Scahill, MSN, PhD; Joel D. Bregman, MD; Craig L. Donnelly, MD; Evdokia Anagnostou, MD; Kimberly Dukes, PhD; Lisa Sullivan, PhD; Deborah Hirtz, MD; Ann Wagner, PhD; Louise Ritz, MBA; for the STAART Psychopharmacology Network
Arch Gen Psychiatry. 2009;66(6):583-590.

Context Selective serotonin reuptake inhibitors are widely prescribed for children with autism spectrum disorders.

Objectives To determine the efficacy and safety of citalopram hydrobromide therapy for repetitive behavior in children with autism spectrum disorders.

Design National Institutes of Health–sponsored randomized controlled trial.

Setting Six academic centers, including Mount Sinai School of Medicine, North Shore–Long Island Jewish Health System, University of North Carolina at Chapel Hill, University of California at Los Angeles, Yale University, and Dartmouth Medical School.

Participants One hundred forty-nine volunteers 5 to 17 years old (mean [SD] age, 9.4 [3.1] years) were randomized to receive citalopram (n = 73) or placebo (n = 76). Participants had autistic spectrum disorders, Asperger disorder, or pervasive developmental disorder, not otherwise specified; had illness severity ratings of at least moderate on the Clinical Global Impressions, Severity of Illness Scale; and scored at least moderate on compulsive behaviors measured with the Children’s Yale-Brown Obsessive Compulsive Scales modified for pervasive developmental disorders.

Interventions Twelve weeks of citalopram hydrobromide (10 mg/5 mL) or placebo. The mean (SD) maximum dosage of citalopram hydrobromide was 16.5 (6.5) mg/d by mouth (maximum, 20 mg/d).

Main Outcome Measures 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 systematically elicited using the Safety Monitoring Uniform Report Form.

Results There was no significant difference in the rate of positive response on the Clinical Global Impressions, Improvement subscale between the citalopram-treated group (32.9%) and the placebo group (34.2%) (relative risk, 0.96; 95% confidence interval, 0.61-1.51; P > .99). There was no difference in score reduction on the Children’s Yale-Brown Obsessive Compulsive Scales modified for pervasive developmental disorders from baseline (mean [SD], –2.0 [3.4] points for the citalopram-treated group and –1.9 [2.5] points for the placebo group; P = .81). Citalopram use was significantly more likely to be associated with adverse events, particularly increased energy level, impulsiveness, decreased concentration, hyperactivity, stereotypy, diarrhea, insomnia, and dry skin or pruritus.

Conclusion Results of this trial do not support the use of citalopram for the treatment of repetitive behavior in children and adolescents with autism spectrum disorders.

The authors contrasted their findings with results from several other studies showing benefits from SSRIs. They concluded that “although there may be differences in response to particular SSRIs among this population, at present there is insufficient research evidence to merit a clear recommendation regarding the use of SSRIs as a class for the treatment of repetitive behaviors in children with ASDs.”

Link to the abstract and to the full article (may be available to some readers).