|Citalopram No Better Than Placebo Treatment
for Children with Autism Spectrum Disorders
Citalopram, a medication commonly prescribed to children with
autism spectrum disorders (ASD), was no more effective than a placebo
at reducing repetitive behaviors, according to researchers funded
by the National Institute of Mental Health (NIMH) and other NIH
institutes. The study was published in the June 2009 issue of Archives
of General Psychiatry.
"Parents of children with autism spectrum disorders face
an enormous number of treatment options, not all of which are research-based," said
NIMH Director Thomas R. Insel, M.D. "Studies like this help
us to better understand which treatments are likely to be beneficial
The researchers say their findings do not support using citalopram
to treat repetitive behaviors in children with ASD. Also, the greater
frequency of side effects from this particular medication compared
to placebo illustrates the importance of placebo-controlled trials
in evaluating medications currently prescribed to this population.
Citalopram is in a class of antidepressant medications called
selective serotonin reuptake inhibitors (SSRIs) that is sometimes
prescribed for children with ASD to reduce repetitive behaviors.
These behaviors, a hallmark of ASD, include stereotypical hand
flapping, repetitive complex whole body movements (such as spinning,
swaying, or rocking over and over, with no clear purpose), repetitive
play, and inflexible daily routines.
Past research suggested that some children with ASD have abnormalities
in the brain system that makes serotonin, a brain chemical that,
among many other functions, plays an important role in early brain
development. Children with obsessive compulsive disorder (OCD)
may also have serotonin abnormalities and have repetitive or inflexible
behaviors. OCD is effectively treated with SSRIs, leading some
researchers to wonder whether similar treatment may reduce repetitive
behaviors in children with ASD. So far, studies have produced mixed
results, but SSRIs remain among the most frequently prescribed
medications for children with ASD.
Researchers in the Studies to Advance Autism Research and Treatment
(STAART) network, funded by five NIH institutes, conducted a six-site,
randomized controlled trial comparing the effectiveness and safety
of using the SSRI citalopram (Celexa) versus placebo to treat repetitive
behaviors in children with ASD. The study included 149 participants,
ages 5–17, who had autism, Asperger disorder, or pervasive developmental
disorder-not otherwise specified (PDD-NOS).
After 12 weeks of treatment, roughly 1 out of 3 children in both
groups—32.9 percent of those treated with citalopram and 34.2 percent
those treated with placebo—showed fewer or less severe repetitive
"Adverse symptoms were common in both groups, probably reflecting
common childhood ailments as well as the changing nature of symptoms
associated with ASD," according to Bryan King, M.D., director
of child and adolescent psychiatry at Seattle Children’s Hospital
and lead author on the study. However, reports of increased energy,
impulsiveness, decreased concentration, hyperactivity, diarrhea,
insomnia, and dry skin were more common in the citalopram group.
According to the researchers, the study results may challenge
the underlying premise that repetitive behaviors in children with
ASD are similar to repetitive and inflexible behaviors in OCD.
The authors on the paper include Bryan H. King, M.D., Seattle
Children’s Hospital; Eric Hollander, M.D., Mount Sinai School of
Medicine; Linmarie Sikich, M.D., University of North Carolina,
Chapel Hill; James T. McCracken, M.D., University of California
Los Angeles; Lawrence Scahill, M.S.N., Ph.D., Yale University;
Joel D. Bregman, M.D., North Shore Long Island Jewish Health System;
Craig L. Donnelly, M.D., Dartmouth Medical School; Evdokia Anagnostou,
M.D., Mount Sinai School of Medicine (currently at the University
of Toronto); Kimberly Dukes, Ph.D., DM-STAT; Lisa Sullivan, Ph.D.,
Boston University; Deborah Hirtz, M.D., National Institute of Neurological
Disorders and Stroke (NINDS); Ann Wagner, Ph.D., NIMH; Louise Ritz,
M.B.A., NIMH (currently at NINDS); and the STAART Psychopharmacology
The STAART network is jointly funded by NIMH, NINDS, the Eunice
Kennedy Shriver National Institute of Child Health and Human Development
(NICHD), the National Institute on Deafness and Other Communication
Disorders (NIDCD), and the National Institute of Environmental
Health Sciences (NIEHS), all part of the National Institutes of
The mission of the NIMH is to transform the understanding and
treatment of mental illnesses through basic and clinical research,
paving the way for prevention, recovery and cure. For more information,
The National Institutes of Health (NIH) — The Nation's
Medical Research Agency — includes 27 Institutes and Centers
and is a component of the U.S. Department of Health and Human Services.
It is the primary federal agency for conducting and supporting basic,
clinical and translational medical research, and it investigates
the causes, treatments, and cures for both common and rare diseases.
For more information about NIH and its programs, visit www.nih.gov.