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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by SLS on June 1, 2009, at 17:25:01
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 and safe."
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 symptoms.
"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 Network.
Posted by bleauberry on June 1, 2009, at 20:23:37
In reply to Citalopram (Celexa) is ineffective for autism., posted by SLS on June 1, 2009, at 17:25:01
I'm not surprised. Enhancing serotonin activity would have practically nothing to do with autism, as I see it.
Autism is a mystery in every medical profession. But in the alternative/integrative medical profession, they have at least discovered things that work pretty well and sometimes completely.
Those things include:
Gluten free diets.
Cassein free diets.
Antibacterial treatments.
Antifungal treatments.
Heavy metal chelation treatments.Unlike the approach of Celexa to somehow mitigate the symptoms, the above approaches get to the core of the cause of those symptoms, even though the entire treatment protocol is guess, trial and error.
Autism kids have vastly improved on DMSA chelation. Also with modified diets. Also with treatments that mimic those for Lyme-like or Candida.
All of the above things are actually tied in one. They are not separate. Where there are heavy metals, there is yeast, there is a compromised immmune system, there is leakage in the intestines, etc. The chain could start anywhere. Maybe it starts with yeast first, which attracts and holds the everyday metals, which then throws every single bodily function into haywire operation. Maybe it started with Lyme from the womb. Maybe it started with mercury in the womb from mamma's amalgams. Maybe it was from the preservative in vaccinations that happens to contain mercury. Maybe that's why autism exploded about the time they came out with that preservative. Genetic susceptibility? No matter, the symptoms of autism are similar to what would be expected if someone were injected with mild neurotoxins, some mildly contaminated alcohol, something along those lines. Because that is exactly what all the above conditions do. And maybe that's why pioneering mothers by the hundreds or thousands all across the country have significant success saving their children when their doctors can't.
These mothers have become experts that blow those Celexa researchers in the weeds.
Posted by SLS on June 1, 2009, at 20:50:01
In reply to Re: Citalopram (Celexa) is ineffective for autism., posted by bleauberry on June 1, 2009, at 20:23:37
Hi BB.
My doctor recently gave a presentation that demonstrated an association between the prevalence of autism and the population ranges of Lyme Disease carrying tics. The overlap on the map was compelling.
- Scott
Posted by Jay_Bravest_Face on June 1, 2009, at 22:01:22
In reply to Citalopram (Celexa) is ineffective for autism., posted by SLS on June 1, 2009, at 17:25:01
Yea...Serzone (nefadazone) is a popular med with the autistic folks I work with. They think it is the 5HT2a antagonism.
Jay
Posted by Phillipa on June 1, 2009, at 23:16:38
In reply to Re: Citalopram (Celexa) is ineffective for autism., posted by SLS on June 1, 2009, at 20:50:01
Scott so you're saying that lyme's was and is a risk factor? Phillipa
Posted by SLS on June 2, 2009, at 5:23:19
In reply to Re: Citalopram (Celexa) is ineffective for autism. » SLS, posted by Phillipa on June 1, 2009, at 23:16:38
> Scott so you're saying that lyme's was and is a risk factor? Phillipa
My doctor is very interested in Lyme and its presentations. I don't know what clued him in to the association with autism, but the overlap in geographical ranges is striking. This does not prove cause-and-effect. I have no reason to believe otherwise, though. I think it is something that scientists should take a closer look at.
- Scott
Posted by Phillipa on June 2, 2009, at 19:58:08
In reply to Re: Citalopram (Celexa) is ineffective for autism. » Phillipa, posted by SLS on June 2, 2009, at 5:23:19
Interesting as it presents all over the world in differents strains of bacteria. Phillipa getting to Columbia newsletter now also on lymes.
Posted by Sigismund on June 3, 2009, at 17:16:03
In reply to Re: Citalopram (Celexa) is ineffective for autism., posted by bleauberry on June 1, 2009, at 20:23:37
Excuse me if this has already been covered.
Since autistic people seem to be sensitive to drug effects and on a sample of one (Temple Grandin, the autistic professor of animal behaviour somewhere in the US where she designs animal handling units) I wonder if ultra low doses of SSRIs would be useful.
She found they turned down the noise, at any rate.
Posted by Sigismund on June 3, 2009, at 17:17:17
In reply to Re: Citalopram (Celexa) is ineffective for autism., posted by SLS on June 1, 2009, at 20:50:01
There have been doctors who have observed a correlation between D3 deficiency and autism.
Posted by Sigismund on June 3, 2009, at 17:20:16
In reply to Re: Citalopram (Celexa) is ineffective for autism. » Phillipa, posted by SLS on June 2, 2009, at 5:23:19
http://www.lef.org/LEFCMS/aspx/PrintVersionMagic.aspx?CmsID=116356
Posted by Phillipa on June 3, 2009, at 21:22:19
In reply to Re: Citalopram (Celexa) is ineffective for autism., posted by Sigismund on June 3, 2009, at 17:20:16
Even my endo tested my D levels is it D3 that's the most important one? PJ
Posted by Phillipa on June 3, 2009, at 21:57:42
In reply to Re: Citalopram (Celexa) is ineffective for autism. » Sigismund, posted by Phillipa on June 3, 2009, at 21:22:19
Another source same med. Phillipa
From Medscape Medical News
Citalopram Ineffective for Treatment of Repetitive Behaviors in Children With Autism
Caroline CasselsMedication Guide
Important Safety Information
Full Prescribing Information
Read more June 2, 2009 The selective serotonin-reuptake inhibitor (SSRI) citalopram (Celexa, Forest Pharmaceuticals) appears to be no more effective than placebo at reducing repetitive behaviors in children with autism spectrum disorders (ASD) a finding that calls into question the currently widespread practice of prescribing SSRIs in this patient population in the absence of scientific evidence.A multicenter, randomized, placebo-controlled trial showed no significant difference in the rate of positive response on the Clinical Global Impressions (CGI) Improvement subscale between the citalopram-treated group (32.9%) and the placebo group (34.2%).
Furthermore, children in the active-treatment group were significantly more likely than those in the placebo group to experience at least 1 treatment-related adverse event 97.3% vs 86.8%.
"Adverse symptoms were common in both groups, probably reflecting common childhood ailments as well as the changing nature of symptoms associated with ASD. However, reports of increased energy, impulsiveness, decreased concentration, hyperactivity, diarrhea, insomnia, and dry skin were more common in the citalopram group," lead author Bryan H. King, MD, from Seattle Children's Hospital, in Washington, said in a statement.
The study is published in the June issue of Archives of General Psychiatry.
Multibillion Dollar Market
ASDs are characterized by impaired social interaction, communication problems, unusual preoccupations, and repetitive behavior. Repetitive behaviors, which can involve stereotypic movements, inflexible routines, repetitive play, and perseverative speech, are the strongest predictors that an early ASD diagnosis will endure, the authors note.
Previous research has suggested there are similarities between ASDs and obsessive-compulsive disorder (OCD). As a result, antiobsessional agents such as SSRIs have been of interest.
However, the authors point out, there are currently no Food and Drug Administrationapproved agents to treat the core symptoms of ASDs. Despite this, medication use in this population has become increasingly common, with SSRIs accounting for 59% of a global market for autism therapeutics that is estimated to be between $2.2 and $3.5 billion.
"There is growing recognition that children and adolescents with ASDs have serious behavioral problems and psychiatric symptoms that may be appropriate targets for pharmacotherapy. To date, there are few large-scale trials to guide clinical practice, so clinicians are left to address these problems with inadequate information."
However, the investigators point out that "despite the relative dearth of evidence supporting their use, SSRIs are among the most frequently used medication for children with autism, partially because of their perceived safety."
The goal of the study was to assess the safety of citalopram as well as its efficacy in improving global functioning by reducing repetitive behaviors.
Sponsored by the National Institutes of Health, the Studies to Advance Autism Research and Treatment (STAART) network undertook the 12-week, placebo-controlled trial, which included 149 volunteers age 5 to 17 years with ASDs, Asperger's disorder, or pervasive developmental disorder not otherwise specified.
All participants had at least moderate illness measured on the CGI Severity of Illness Scale and scored at least moderate on compulsive behaviors as measured with the Children's Yale-Brown Obsessive Compulsive Scales modified for pervasive developmental disorders.
The study's primary end point was defined as a score of much improved or very much improved on the CGI Severity of Illness Scale. Subjects were randomized to receive citalopram (n = 73) or placebo (n = 76). Citalopram subjects received a maximum daily dose of 20 mg by mouth.
Urgent Need for Large, Multicenter Trials
At the end of the study, roughly 1 out of 3 children in both groups 32.9% in the citalopram group and 34.2% in the placebo group showed fewer or less severe repetitive symptoms.
According to the researchers, these findings may challenge the underlying premise that repetitive behaviors in children with ASD are similar to repetitive and inflexible behaviors in OCD.
"The results of this trial indicate that citalopram is not an effective treatment for children having ASDs with moderate or greater repetitive behavior. The results also highlight the urgent need for placebo-controlled trials of medications commonly used for children with ASDs to determine whether the risks of specific drugs substantially outweigh their benefits," the authors write.
In an accompanying editorial, Fred R. Volkmar, MD, from the Yale Child Study Center, in New Haven, Connecticut, said the study is "an important step that addresses this major gap in the literature."
Dr. Volkmar pointed out that the study by Dr. King and colleagues is the largest randomized medication trial in children with autism and ASDs.
"We need more studies of this kind to advance research and guide clinical practice. The commitment of the National Institutes of Health to support well-designed multisite clinical trials should be applauded. Conducting such studies today, when there are so many constraints on funding, will be difficult but no less important," writes Dr. Volkmar.
The study was funded by the National Institutes of Health. The authors report no relevant conflicts of interest.
Arch Gen Psychiatry. 2009;66:583-590, 581-582.
Posted by Sigismund on June 5, 2009, at 17:35:55
In reply to Re: Citalopram (Celexa) is ineffective for autism., posted by bleauberry on June 1, 2009, at 20:23:37
>Maybe it was from the preservative in vaccinations that happens to contain mercury.
There must have been many parents who have been shocked by the effect vaccination (but which one? I forget) sometimes has on their very young children. (I don't want to argue about vaccination though.)
I remember a doctor writing about the combination of various vaccinations in a tight schedule with mercury preservatives....something about what the immune system could handle, and she made the point that good doctors learn from listening to their patients.
Posted by Phillipa on June 5, 2009, at 20:40:18
In reply to Re: Citalopram (Celexa) is ineffective for autism., posted by Sigismund on June 5, 2009, at 17:35:55
That's what an ex-neighbor said caused her Son's Autism. Love PJ
Posted by linkadge on June 9, 2009, at 7:46:05
In reply to Re: Citalopram (Celexa) is ineffective for autism. » Sigismund, posted by Phillipa on June 5, 2009, at 20:40:18
I could have told you SSRI's don't work for autism. Infact, citalopram almost made me a little autistic.
Linkadge
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