Lack of Efficacy of Citalopram in Children with Autism Spectrum Disorders and High Levels of Repetitive Behaviors
King, B.H., Hollander, E., Sikick, L., McCracken, J.T., Scahill, L., Bregman, J.D., Donnelly, C.L., Anagnostou, E., Dukes, K. , Sullivan, L., Hirtz, D., Wagner, A., Ritz, L. (2009). Lack of efficacy of citalopram in children with autism spectrum disorders and high levels of repetitive behaviors. Archives of General Psychiatry, 66(6), 583-590.
Reviewed by Amy Hansford, MA
Why study this topic?
Medication to treat the symptoms of autism spectrum disorders has become increasingly frequent. One commonly prescribed class of medications are the selective serotonin reuptake inhibitors (SSRIs), which have been used in an effort to reduce repetitive behaviors. However, little research is available on the effectiveness of this treatment.
What did the researchers do?
The researchers in this study conducted a randomized clinical trial at six centers in the United States to test the effectiveness of the SSRI citalopram hydrobromide (Celexa) for reducing repetitive behaviors. Participants were 149 children between the ages of five and 17, with a diagnosis of autism, Asperger’s disorder, or pervasive developmental disorder, not otherwise specified, and displayed at least moderate levels of repetitive behaviors at the start of the study.
Each participant received either liquid citalopram (Celexa) or a non-medication placebo over a 12-week period. In order to minimize bias, neither the participants nor the study doctors were told which substance the participants were taking during the course of the trial. Study doctors monitored the participants for safety, as well as for changes in overall functioning, repetitive behaviors, aggression, and irritability. Parents were also asked to complete a questionnaire at every visit regarding their child’s repetitive behavior.
What did the researchers find?
Researchers found no significant improvement in repetitive behavior or overall functioning for the participants taking citalopram compared to those taking the placebo. The citalopram group did show a decrease in irritability, but the change was very small and was not considered clinically significant. In addition, the citalopram group was much more likely to experience side-effects than those on the placebo, with 97.3% of participants reporting at least one side-effect.
What were the strengths and limitations of the study? What do the results mean?
Researchers concluded that citalopram was no more beneficial than placebo for children with autism but was more likely to produce side-effects. Given the large number of study participants and careful research design, this study suggests that citalopram is unlikely to reduce repetitive behavior, and the results highlight a need to further evaluate other commonly prescribed medications for their safety and effectiveness.