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Review
. 2021 Oct 1;7(6):e179.
doi: 10.1192/bjo.2021.1003.

Randomised controlled trials of antidepressant and anti-anxiety medications for people with autism spectrum disorder: systematic review and meta-analysis

Shoumitro Deb  1 , Meera Roy  2 , Rachel Lee  3 , Madiha Majid  4 , Bharati Limbu  1 , Jacopo Santambrogio  5 , Ashok Roy  4 , Marco O Bertelli  6
Affiliations
Review

Randomised controlled trials of antidepressant and anti-anxiety medications for people with autism spectrum disorder: systematic review and meta-analysis

Shoumitro Deb et al. BJPsych Open. .

Abstract

Background: Although widely used, the current evidence for the efficacy of antidepressant and anti-anxiety medications for people with autism spectrum disorder (ASD) is limited and conflicting.

Aims: We carried out a systematic review and meta-analysis of randomised controlled trials that assessed the effectiveness of these medications in people with ASD.

Method: We searched the following databases: Cochrane Library, Medline, EMBASE, CINAHL, PsycINFO, ERIC, DARE and ClinicalTrials.gov. Additionally, we hand-searched 11 relevant journals. We used the Cochrane risk-of-bias tool and Jadad score to assess the quality of each included study. We carried out a meta-analysis using a random effects model.

Results: We included 15 randomised controlled trials (13 on antidepressants and two on anti-anxiety medications) for a total of 958 people with ASD. Data showed contradictory findings among the studies, with larger studies mostly showing a non-significant difference in outcomes between the treatment and the placebo groups. Meta-analysis of pooled Yale-Brown Obsessive Compulsive Scale and Clinical Global Impression Scale data from nine studies (60%) did not show any statistically significant inter-group difference on either of the outcome measures. The adverse effects reported were mild and, in most studies, their rates did not show any significant inter-group difference.

Conclusions: Given the methodological flaws in the most included studies and contradictory findings, it is difficult to draw any definitive conclusion about the effectiveness of either antidepressant or anti-anxiety medications to treat either ASD core symptoms or associated behaviours. Robust, large-scale, randomised controlled trials are needed to address this issue.

Keywords: Autism spectrum disorder; anti-anxiety medications; antidepressants; meta-analysis; systematic review.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) flow chart of paper selection. ASD, autism spectrum disorder.
Fig. 2
Fig. 2
Cochrane risk-of-bias summary scores.–
Fig. 3
Fig. 3
Forest plot based on the Children-Yale-Brown Obsessive Compulsive Scale (Y-BOCS) pooled data.
Fig. 4
Fig. 4
Forest plot based on the Clinical Global Impression-Improvement Scale (CGI-I) pooled data.
See this image and copyright information in PMC

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