Citalopram no good for autism

8 Jun

An interesting study for me personally as it involves a crazymed I’m familiar with – Citalopram (the generic name) brand name Celexa in the US and Cipramil over here in Blighty.

Citalopram is an anti-depressant of the class SSRI which means ‘selective serotonin reuptake inhibitors’. In plain english an SSRI based crazymed stops serotonin being reuptaken and therefore your neurons wallow for longer in it. This is, apparently, good. Why? I don’t know, I am not a scientist, I am a user 🙂 Well, I’m not anymore, I take a different sort of anti-depressant crazymed called Venfalaxine which is an SNRI. I don’t know how that works either but it does and thats good enough for me. Hopefully it has plenty of formaldehyde and monkey kidneys in it.

Anyway, I had no idea that Citalopram was used off-label for autism and when I heard about this study my first thoughts were ‘what the hell did they expect it to do?’ Shortly followed by ‘Citalopram is some serious shit’.

What the hell did they expect it to do? They expected it to reduce repetitive behaviours.

Seriously.

They put these kids on heavy duty SSRI’s because they flapped their hands and rocked back and forth. Excuse me for being a little rude here but so fucking what?

Apparently

Side effects were more common in the children taking Celexa, the researchers found. Those on Celexa were more likely to have increased energy levels, impulsiveness, decreased concentration, hyperactivity, mechanical repetition of the same movement or posture, and sleep problems.

Oh wait, all the symptoms of the beginnings of what to me sounds like hypomania. Which is (gasp!) a side-effect of most if not all SSRI’s.

Because they flapped and rocked and swayed and liked routine. Good call.

“A medication that we thought would be helpful for these repetitive behaviors was no better than placebo,” he [Bryan H. King] says. “That calls into question how or if we should use [Celexa] or even related medications for this purpose.

Yeah? Does it? How about we call into question the necessity of drugging the shit out of a kid because s/he likes to rock and flap?

I have to wonder, I really do. How the hell did this study – which to me sounds more like torture – ever get past an IRB?

Apologies for the rant but this is appalling to me.

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20 Responses to “Citalopram no good for autism”

  1. passionlessDrone June 9, 2009 at 02:32 #

    Hi Kev –

    I saw a couple of news stories on this that indicated a full third of children with autism were on this drug. I have serious problems believing that, I don’t think I know any.

    It seems likely that they thought this might work due to some studies that seemed to show effectiveness in conditions like OCD/ADHD. Did they actually work in those studies? Who knows.

    There are so other trials of a variety drugs that share a similar mechanism of action of SSRIs, that show promise in autism; many have promising results in conditions like Alzheimer’s. They target different receptors and/or messengers. We are on the cusp of having means to address the concept of being simply differently wired; though if that is a good thing or not is heavily subjective.

    – pD

  2. lisanavi June 9, 2009 at 02:37 #

    I’ve taken citalopram as well. pharmacist told me it was the same after digestion as its stereoisomer, lexapro. Lexapro lacks a cheaper generic version. Celexa has a really cheap generic version. well, um, not on me. I forget lexapro, or escitalopram, for a few days, I um, can get pretty depressed. that’s it. I forget citalopram, for just one day, I can’t sleep, am irritable, etc, etc, etc. oh, and it didnt work as well as lexapro. I no like citalopram. and I, um, only have somewhat ‘functional’ depression… (functional as in I can usually keep my job, deal with my bipolar husband when he’s not on meds, and take care of my kids. cleaning house goes to all holy hell though)

  3. strangetherapy June 9, 2009 at 06:57 #

    Hmm – curious. I’ll have to see if I can get some information on what mechanism they thought it might work on, if any. It certainly seems an odd one to throw out there.

    Citalopram works an odd charm on my legs, which are often either bouncing, shaking or sliding and kicking around (partly to reduce the peculiar pain the drug induces). When I first started treatment I found it quite hard to stay still and would be constantly stretching, twitching, tapping and the like – I think it’s referred to as akathesia in the literature. Subjectively, the sensation was related to the drug-induced hypomania I can be prone to, but certainly not identical.

    Hmm.

  4. Kev June 9, 2009 at 07:30 #

    pD I know a variety of people who use it for a wide range of off-label and almost-on-label uses such as OCD, anxiety disorders and the depressive side of bipolar.

    I guess if the autistic person in questions has a comorbid diagnosis of depression an SSRI is a valid treatment (although for any bipolar person any form of anti-depressant has to be carefully monitored) but for autism? Scary.

    Navi – Lexapro is anecdotally better tolerated than this. I’d go back to that if you can.

  5. SueBowler June 9, 2009 at 09:02 #

    That is really interesting and thank you for sharing the information. As a psychotherapist, I have seen some excellent responses to Citalopram where clinical depression is the primary presentation, and if the client feels that medication is required, it is the first drug I usually suggest in a dialogue between client, GP and myself.
    I had not seen that study on how it affects people with autism, and like you am similarly outraged that personal expressions should be seen to need ‘treatment’. I agree entirely with your comments.

  6. Harry June 9, 2009 at 20:12 #

    “I guess if the autistic person in questions has a comorbid diagnosis of depression an SSRI is a valid treatment”

    No it’s not. The cause of the depression should be found and dealt with before Mr Shrink’s let out of his/her dungheap.

    Drugs are bad. M’kay?

    SueBowler:

    “it is the first drug I usually suggest in a dialogue between client, GP and myself”

    Umm, what exactly is your clinical qualification that gives you licence to make such a suggestion?

    Answers on a post card or the back of a sealed down envelope to the usual address.

  7. cpu52362 June 9, 2009 at 20:16 #

    I too was on citalopram for a while. I also noticed a great sleep disturbance trying to withdraw from it. To me it seems that none of the SSRI/SNRI’s work on my depression. I was on a pretty big dose of Serzone at one time too, I think I remember it giving me some visual side effects too, but thats another drug.

    At this time I am struggling along depression aspergers and all without any support. (And I beleive I need support, but people supports/services more than attempted adjustment of neurotransmitter levels they still ‘beleive’ are involved.)

    I too hate to see them try to tranquilize or anti-depress us into more normal behavior, if its not necessary. (the great debate)

  8. Kev June 9, 2009 at 20:22 #

    You’re right that drugs shouldn’t be the first thing to be reached for Harry but for some they’re necessary. I have no idea what I’d be like (well yes I do – not good) without the regime I’m on.

  9. SueBowler June 9, 2009 at 23:55 #

    Hi Harry
    As I said, it is a *suggestion*, nothing more, and as I stated in my post I only do so IF a client asks me first. I am qualified to do what I do (not that I think it is any great big deal; nothing more, and frankly I don’t feel a need to justify that; I just do the best I can and, yes, often it is not enough. I work hard in the mental health arena and am passionate about it. I do not advocate the use of drugs unnecessarily; I believe that if they can be avoided at all, then that is the thing to aim for. However, I realise that this is not possible for everybody, and my endeavour is to be pro-active in promoting choice and to be respectful about each individual’s decisions.

  10. SueBowler June 10, 2009 at 00:11 #

    Also, I would like to thank you, Kev, for hosting this interesting and interactive forum.

  11. Kev June 10, 2009 at 07:23 #

    Well Sue, no problem, LBRB is co-written by 4 or 5 people without whom it would go back to just being my own rant space 😉 and both you and Harry are definitely a valued reader and (hint hint 😉 ) I’d love to have him as a writer on here too.

  12. Harry June 10, 2009 at 09:53 #

    point taken (both actually). will get my brain in order…

  13. Louise Bach Capps June 10, 2009 at 22:57 #

    Just wanted to note that the kids in this study were given 16.5 mg of Celexa. Many autistic kids are given much, much less: 1 or 1.5 mg. The very low dose is supposed to help in a way that the larger dose doesn’t? Not sure who (if anyone!) has the science to support this.

  14. Arthur_ June 11, 2009 at 21:11 #

    A lower dose would be expected to cause less side-effects.
    Pity that there is no evidence of the expected effect at high dose.
    Unless has an bizarre dose-response, it strongly suggest not to use it on autistic kids, unless they are being treated for depression (not a common occurence in young kids).

  15. me.yahoo.com/a/xM9hDy8o1uR4_vrVM0e0EmIzGPMInrg5Ag-- June 12, 2009 at 14:13 #

    .
    .
    Kevin dear, flapping hand and rocking is a part of repetitive behaviors. And, yes. So what? But my daughter’s repetitive behaviors reached the point that if we stopped any of them we were beaten, her teachers were beaten, the walls of our home were kicked in, the wind screens of our cars were smashed, televisions were thrown to the floor, tables were tossed over during meals, and on and on. Daughter was placed on all sorts of meds and none had an effect. Others caused serious side effects. Docs insisted there be some med in play for OCDs and we moved on to Lexapro. Never saw a benefit. Insurance stopped paying for Lexapro and we moved on to Celexa. Never saw a benefit. Now I am glad to see this study so we can move on to something new that may actually benefit. But, repetitive can be a big So What. Flapping and humming are the least of the problems.

  16. Joseph June 12, 2009 at 17:10 #

    But my daughter’s repetitive behaviors reached the point that if we stopped any of them we were beaten

    Why was there an attempt to stop the behaviors?

    I would also be inclined to beat anyone who attempted to stop any behavior I find necessary to deal with stress.

  17. passionlessDrone June 12, 2009 at 19:02 #

    Hi Joseph –

    Why was there an attempt to stop the behaviors?

    I would also be inclined to beat anyone who attempted to stop any behavior I find necessary to deal with stress.

    Are there any situations in which you believe that there is a reasonable reason to attempt to stop these types of behaviors?

    In any case, I don’t know about the yahoo text string poster, but with my son, when he is in school, his teachers (and I) don’t want him spending all of his time flapping his hands instead of trying to learn. In the bathtub, repetitively flapping and rocking is inappropriate, not just because it makes it impossible to get him clean, but it can be a dangerous place to be jumping around. What if if we need to spend twenty minutes at the library? What if we go into a crowded elevator? What about an airplane? What about a crowded restaraunt? He also has given himself a tangerinze sized purple bruise on his arm, the result of flapping his hand so violently that it snaps back into the underside of his arm. I’m not OK with that.

    I’m all in favor of helping children find ways to deal with their stress, or as the case may be, their excitement, but there are a thousand situations where some behaviors aren’t OK, regardless of if the person performing them feels strongly compelled to do them. I’m not advocating psychotropics here, far from it; but I think that there are valid reasons to try to modify behavior, and tend to believe the yahoo commentator likely had valid reasons for making such an attempt.

    – pD

    (ps. edited due to blockquoting / italicized problems)

  18. Joseph June 12, 2009 at 19:41 #

    Are there any situations in which you believe that there is a reasonable reason to attempt to stop these types of behaviors?

    Only if it’s reasonable to suppose they are significantly interfering with another person’s freedom of behavior. This is not behavior modification, in my view.

    For example, you should not be noisy in a movie theater. You should not be waking up someone who’s sleeping. A lot of these things are basic child discipline. Of course, they might not be easy to teach to an autistic child (remember, I’m a parent too) but that’s basically how I think they should be approached, not as “behavior modification.”

  19. me.yahoo.com/a/xM9hDy8o1uR4_vrVM0e0EmIzGPMInrg5Ag-- June 13, 2009 at 03:22 #

    .
    .
    There was an attempt to stop behaviors because some of my daughter’s repetitive behaviors caused damage to property and physical harm to herself.

  20. Arthur_ June 15, 2009 at 20:52 #

    Well, now Citalopram is proved not to stop flapping.

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