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. 2013 Aug 20;2013(8):CD004677.
doi: 10.1002/14651858.CD004677.pub3.

Selective serotonin reuptake inhibitors (SSRIs) for autism spectrum disorders (ASD)

Katrina Williams  1 , Amanda Brignell, Melinda Randall, Natalie Silove, Philip Hazell
Affiliations

Selective serotonin reuptake inhibitors (SSRIs) for autism spectrum disorders (ASD)

Katrina Williams et al. Cochrane Database Syst Rev. .

Abstract

Background: Autism spectrum disorders (ASD) are characterised by abnormalities in social interaction and communication skills, as well as stereotypic behaviours and restricted activities and interests. Selective serotonin reuptake inhibitors (SSRIs) are prescribed for the treatment of conditions often comorbid with ASD such as depression, anxiety and obsessive-compulsive behaviours.

Objectives: To determine if treatment with an SSRI:1. improves the core features of autism (social interaction, communication and behavioural problems);2. improves other non-core aspects of behaviour or function such as self-injurious behaviour;3. improves the quality of life of adults or children and their carers;4. has short- and long-term effects on outcome;5. causes harm.

Search methods: We searched the following databases up until March 2013: CENTRAL, Ovid MEDLINE, Embase, CINAHL, PsycINFO, ERIC and Sociological Abstracts. We also searched ClinicalTrials.gov and the International Clinical Trials Registry Platform (ICTRP). This was supplemented by searching reference lists and contacting known experts in the field.

Selection criteria: Randomised controlled trials (RCTs) of any dose of oral SSRI compared with placebo, in people with ASD.

Data collection and analysis: Two authors independently selected studies for inclusion, extracted data and appraised each study's risk of bias.

Main results: Nine RCTs with a total of 320 participants were included. Four SSRIs were evaluated: fluoxetine (three studies), fluvoxamine (two studies), fenfluramine (two studies) and citalopram (two studies). Five studies included only children and four studies included only adults. Varying inclusion criteria were used with regard to diagnostic criteria and intelligence quotient of participants. Eighteen different outcome measures were reported. Although more than one study reported data for Clinical Global Impression (CGI) and obsessive-compulsive behaviour (OCB), different tool types or components of these outcomes were used in each study. As such, data were unsuitable for meta-analysis, except for one outcome (proportion improvement). One large, high-quality study in children showed no evidence of positive effect of citalopram. Three small studies in adults showed positive outcomes for CGI and OCB; one study showed improvements in aggression, and another in anxiety.

Authors' conclusions: There is no evidence of effect of SSRIs in children and emerging evidence of harm. There is limited evidence of the effectiveness of SSRIs in adults from small studies in which risk of bias is unclear.

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Conflict of interest statement

Professor Katrina Williams gave a talk about treatments for autism at a symposium organised by Janssen‐Cilag Pty Ltd. Janssen‐Cilag had no control over the contents of the talk and the speaker's fee was paid to the University that employs her. She has no ongoing relationship with Janssen‐Cilag. She is an editor with the Cochrane Developmental, Psychosocial and Learning Problems Group.

Professor Philip Hazell has worked as a consultant for Eli Lilly and Janssen. He has had research contracts with Eli Lilly and Celltech. He is a member of the advisory board of Eli Lilly, Australia; Janssen, Australia; Novartis, Australia; and Shire, International. Professor Hazell has given presentations for Eli Lilly, Pfizer, Janssen and Sanofi. He is an investigator on a non‐industry funded trial of fluoxetine for autism spectrum disorders. In the past 36 months Philip Hazell’s institution has received payment from Lilly and Shire for his participation in advisory boards; Lilly, Janssen, Pfizer and Shirer for speaker’s bureau. Professor Hazell is an editor with the Cochrane Developmental, Psychosocial and Learning Problems Group.

Associate Professor Natalie Silove is an investigator on a non‐industry funded trial of fluoxetine for autism spectrum disorders. Children's Hospital Westmead is enrolling up to eight participants in a phase two drug trial in adolescence with Fragile X syndrome. She receives no personal funds at all.

Dr Melinda Randall has no conflict of interest to declare.

Ms Amanda Brignell has no conflict of interest to declare.

Figures

1
1
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
2
2
Forest plot of comparison: Proportion improved for Clinical Global Impression Improvement (CGI‐I)
1.1
1.1. Analysis
Comparison 1 Proportion improved for Clinical Global Impression Improvement (CGI‐I), Outcome 1 Clinical Global Impression ‐ Improvement (CGI‐I).
See this image and copyright information in PMC

Update of

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