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June 1, 2009 --The antidepressant Celexa, often prescribed for children with autism and autism spectrum disorders (ASD) to reduce repetitive behaviors, works no better than a placebo, according to a new study.
Even worse, the medication was more likely than the placebo to produce adverse side effects such as increased energy, impulsiveness, and decreased concentration, the researchers found.
The study findings were a surprise, says the study's lead author Bryan H. King, MD, director of child and adolescent psychiatry at Seattle Children's Hospital and professor and vice-chairman of psychiatry at the University of Washington School of Medicine. "We were fully expecting to demonstrate the value of this drug," he tells WebMD.
"A medication that we thought would be helpful for these repetitive behaviors was no better than placebo," he says. "That calls into question how or if we should use or even related medications for this purpose."
Repetitive behaviors in children with autism or ASD include asking the same question over and over; repeating body movements, such as swaying or spinning; or insisting on inflexible daily routines, such as taking the same route to school.
The study is published in the Archives of General Psychiatry and was funded by the National Institutes of Health.
Although antidepressant drugs such as Celexa aren't approved by the FDA to treat the repetitive behaviors of children with autism or ASD, they are widely prescribed "off-label", a common and legal practice.
"Surveys suggest about a third of the kids with autism treated with medication are on one of the SSRIs for a variety of symptoms," King says. SSRIs, or selective serotonin reuptake inhibitors, are a family of drugs such as Celexa that work by increasing the level of the brain chemical serotonin, associated with mood and behavior. The SSRIs have been shown to help reduce repetitive behavior in children with obsessive-compulsive disorder, King says.
King and his colleagues evaluated 149 children, aged 5 to 17, all diagnosed with autism or other ASD and being treated at six academic medical centers across the country. They were enrolled from April 2004 through October 2006 and randomly assigned to get either placebo or an average of 16.5 milligrams a day of liquid Celexa.
"Most had autism," King says. All the children had at least a moderate level of repetitive behaviors. The researchers focused on how well the drug reduced these behaviors, evaluating the results by using commonly used scales to show improvement in the behaviors.
After 12 weeks, about one of three children in each group -- 32.9% of those on Celexa and 34.2% of those on placebo -- showed fewer or less severe repetitive symptoms.
Side effects were more common in the children taking Celexa, the researchers found. Those on Celexa were more likely to have increased energy levels, impulsiveness, decreased concentration, hyperactivity, mechanical repetition of the same movement or posture, and sleep problems.