Study questions ASD prescribing

According to the authors, up to one third of children and adolescents with autism spectrum disorders (ASD) are prescribed antidepressants, despite inconclusive evidence of their effectiveness.
 
Led by the Murdoch Children’s Research Institute (MCRI), the clinical trial investigated the ability of fluoxetine (sold as Prozac) to reduce obsessive compulsive behaviours in 146 participants aged 7.5–18 years.
 
Initial results revealed some behavioural changes after taking the drug, but further analysis failed to show any meaningful clinical benefit.
 
Dr James Best, a GP with a special interest in children’s medicine and autism spectrum disorders, told newsGP any research into the area is welcome, and that it should help inform GPs who have patients with these symptoms and conditions
 
‘GPs often have patients who are on these medications even if they’re not the initiator themselves, so having an understanding of whether they may or may not have a limited role in certain situations [is valuable],’ he said.
 
‘It’s perhaps not that widely appreciated, just how common other mental health diagnoses are in combination with ASD … so [GPs need] an awareness of that and where the pharmaceutical treatments can be considered.’
 
Dr Best said even though the study found little evidence to support the use of antidepressants in this context, every prescribing decision needs to be considered with reference to the individual situation.
 
‘In anyone with autism, there is a great deal of co-diagnoses and they lead to a large proportion of the disability of individuals, rather than the autism per se. So while ASD is not treatable with medication, a lot of the co-diagnoses are,’ he said.
 
‘[This trial] adds to the body of research and helps clinicians to be more informed in their prescribing. It doesn’t mean we shouldn’t be using these medications, it just adds to our understanding of how effective or ineffective they are.’
 
The randomised clinical trial recruited patients from The Royal Children’s Hospital, The Sydney Children’s Hospitals Network and the State Child Development Centre, who were randomly assigned to receive either fluoxetine or a placebo.
 
While initial results showed some behavioural improvements, lead author Professor Dinah Reddihough said additional analyses revealed no significant difference between the groups, which should be given more weight because it corrects for any imbalances in the data.
 
‘While this is a study with negative findings, it is an important addition to the evidence base for deciding when and when not to prescribe psychoactive medications,’ she said.
 
‘If parents have any concerns about the use of fluoxetine they should speak with their health professional before changing any treatment plan.’

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antidepressants ASD autism spectrum disorders fluoxetine Prozac