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

Abstract

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.

Multidisciplinary Assessment and Treatment of Self-Injurious Behavior in Autism Spectrum Disorder and Intellectual Disability: Integration of Psychological and Biological Theory and Approach

“…In a study of adults with severe or profound ID and SIB, fluvoxamine treatment led to improvement of SIB and impulse control (La Malfa et al 1997). Similarly, in subjects with ASD, fluvoxamine was shown to improve aggression, and in some cases SIB, in some adults (McDougle et al 1996b), although studies of SSRIs, including fluvoxamine, in children with ASD have failed to show consistent benefits related to SIB or other interfering behavioral symptoms (McDougle et al 1996b;Williams et al 2010). The mixed results from treatment trials of SSRIs make it difficult to know whether these medications are a good choice for treatment of SIB, at least in individuals with ASD.…”

Outcomes in systematic reviews of complex interventions never reached “high” GRADE ratings when compared with those of simple interventions

“…Two reviews contained studies with quasiexperimental methods [63,64]. Two reviews in this group did not conduct quantitative synthesis of estimates [61,62], whereas one review meta-analyzed the data for only one outcome, involving two trials [68].…”

Unmet needs in paediatric psychopharmacology: Present scenario and future perspectives

“…In particular: (a) psychostimulants have been proven effective in reducing the hyperactivity and impulsivity, present in up to a third of ASD cases (Simonoff et al, 2008;Harfterkamp et al, 2012). Their efficacy is somewhat lower compared to effects in children with "pure" ADHD, while side effects (i.e., irritability, lethargy, tics, sadness, and social withdrawal) tend to be more frequent and severe in autistic children with comorbid ADHD (Research Units on Paediatric Psychopharmacology Autism Network, 2005; Simonoff et al, 2013); (b) SGAs, particularly risperidone and aripiprazole, have been shown to control irritability, agitation, compulsions and aggressiveness, with evidence of maintained efficacy for up to 6 months of treatment in the majority of patients (Marcus et al, 2009;Zuddas et al, 2011); (c) SSRIs display some efficacy on anxiety and repetitive behaviours in adults, but not in children and adolescents with autism (Williams et al, 2010). This lack of efficacy in the paediatric ASD population is likely related to age-specific differences in underlying neurobiological mechanisms, to target symptoms (autistic individuals report anxiety as distressing and stereotypic behaviours as relaxing), and to the use of assessment tools and outcome measures that have been validated only in individuals without ASD (Reiersen and Handen, 2011).…”