Prozac treatment for autism

In yesterday’s Guardian I read that

Thousands of children with autism in the UK could benefit from taking drugs such as Prozac, a US psychiatrist said yesterday.

 Professor Eric Hollander, from the Mount Sinai medical centre in New York, said a third of children diagnosed in the United States were on antidepressants and British children were being under-treated. Although the drugs are not licensed for autism, he said there was evidence they could reduce its symptoms, enabling some children to travel on public transport or go to mainstream schools.

It is argued that those drugs may help autistic children, who are obsessed with routine and get distressed if the unexpected happens.

Doctors in Britain have been warned not to prescribe antidepressants for children and adolescents following evidence that the pills may make them become suicidal. Research Autism, a branch of the National Autistic Society, warned that such drugs had worrying side-effects in autistic children. “We advise caution,” a spokesman said. “There has not been enough research to be able to give a clean bill of health to this treatment.”

Professor David Healy, whose research led to the warnings, said: “These drugs have been around for the last 20 years and if there really was any substantial benefit it would have been found a long, long time ago.”

Prozac was the first “lifestyle” drug. It can be a lifesaver for people with a major depressive disorder but is also used by  well people who would like to feel “better than well.” Widespread use by people with minor problems or no problems at all has fostered the illusion that prozac is a totally benevolent “happy pill.” However Prozac is one of a powerful class of psychotropic drugs, selective serotonin reuptake inhibitors, (SSRIs) that can have dangerous side effects. Sarah Boseley, who wrote today’s piece, wrote another story about Prozac and similar SSRIs causing suicidal thoughts in some people.

Dr Healy says the results of the research should be a warning to GPs prescribing any SSRIs. “They may not all be equally the same,” he told the Guardian. “But the risk holds for the whole of the group. Generally the findings would indicate that women and children and those who are least ill may be most at risk.”

Prozac  now carries a “black box” warning.

Prozac is the only SSRI licensed for use with children in the UK following a ruling by the EMEA, and then only for children over the age of eight with moderate or severe depression who have failed to respond to psychological therapies alone. It should only be given in conjunction with continuing therapy and reconsidered if there is no clinical benefit after nine weeks. There are also questions arising from animal studies about the long term effects of Prozac on emotional behaviour, growth and sexual maturation which require further research and careful monitoring in children taking the drug. So it is unlikely that it will be widely prescribed for autistic children here.

But what about the one in three autistic children in the USA? How many of them are so severely depressed that they need to take SSRIs? How many of them are actually the victims of stress induced by unreal expectations and lack of understanding? Professor Hollander touches on this in an interview with Medscape.

There are some controversies about whether autism — for example, Asperger’s disorder — is just an alternative way of being and whether trying to get rid of target symptoms is not allowing certain patients with Asperger’s to fully express who they are.

My sense is that it’s pretty clear that if we can reduce certain target symptoms, then people will have significantly less distress and their overall level of functioning will improve.

I am not anti-drug or anti-psychiatry. For two years Prozac was my lifeline. But my depression did not begin with a chemical imbalance in my brain. That happened because of the cumulative effect of many external factors, not least of which was the stress involved in a long and unsuccessful battle with the authorities to obtain appropriate provision for my autistic son.

If someone is crying we do not give them a pill to dry their tears. We find out why they are crying and try to remove the source of their unhappiness. When it comes to autism we should begin by putting more effort into fixing the situation that these children and adults are often forced into and not automatically assume that they are the ones who need fixing and that we have the wherewithal to do it. If we can identify and alleviate sources of stress in the lives of young autistic children we may reduce the likelihood that they will need medication as they get older.

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13 thoughts on “Prozac treatment for autism

  1. Prozac changed my life for the better. Mostly, it helps with anxiety. Living with anxiety is something I would definately take a cure for. My anxiety has been lifelong and has affected every aspect of my life. Prozac virtually eliminates it. There are some side effects such as decreased sexual desire, but other than that its been a wonder drug for me.

    I believe there is a lot of good research on serotonin levels in autistic brains (I would rely on someone else though to find those studies). As far as suicide, I’ve never thought of it while on prozac.

    Prozac also allows me to feel less anxious around crowds of people. I still don’t like to be where there are a lot of people, but I no longer have the semi panic attack I use to get in crowds.

    I would recommend to anyone that suffers from anxiety to give it a try for 30 days. If you don’t feel the benefits outweigh the side effects (which are very minimal in my case) then you can stop taking it.

  2. I don’t think there’s a lot of good research about serotonin levels in anyone’s brains, the idea of “chemical imbalance” still has no direct proof and was given as a reason why certain drugs work, often before people even understood how the drugs worked. SSRIs are now believed to work (when they even do) through some obscure other thing they do.

    For my part, I mostly found that what they did was eliminate the physical aspect of depression without eliminating the mental aspect. So I would be suicidal already, then take this kind of drug and no longer have the paralyzing effects on my body that were keeping me from acting on those impulses. Not a great thing.

    I also experienced manic and mixed states on some of them, which I normally don’t experience at all (I don’t even experience hypomania on a regular basis normally, let alone mania).

  3. All treatments for depression have increased risk of suicidality when they start to work. That goes for talk therapy too. It is not a property that is unique among SSRIs. I think it has gotten more press among children because families are often in denial that their child is actually depressed (often secondary to other family of origin problems). It is easier to blame the pill than to blame the dysfunctional family of origin, or to blame themselves for not exerting sufficient supervision of a depressed child.

    Has anyone given any thought to the “worrying” side effects of bullying?

  4. Prozac does seem to be beneficial for some. But I find it eyebrow raising that the side effect of this anti-depressant is depression.
    Being autistic doesn’t neatly mean you’re depressed. It doesn’t mean you’re normal or abnormal but how adaptable to society you are. Everyone’s minds are different, but I’ll concede it’s advantageous as a neurotypical (to quote a site by Joel Smith) to be neurotypical.

    This is just another market to push Prozac too. It’s a subtle way of saying “well if we can subdude those people to make ‘em shut up and fill our pockets, well that’s good isn’t it?” It’s urinating on efforts to understand autism better.

  5. I took prozac for refractory migraines from a HEAD INJURY, where I was already on standard treatment for seizures & the rescue meds were ASKING for a stroke.

    It was pretty decent for the migraines. It didn’t do a blessed thing for the autism traits, except maybe making me half an SD less OCDish. Not exactly statistically significant. MY theory is I was less OCD and anxious because I wasn’t puking up my guts, going to the ER, and/or getting steroid shots for yet another medical problem every other night.

    *shrug* but they try THAT stuff on autistic people too. Better prozac than prednisone, if the doc knows his thumb from his bum.

  6. Thanks for the link, apple-m. For once the Mail has done its homework.

    To everyone else,
    I think our varied experiences of Prozac illustrate the old dage that the plural of anecdote is not data. and if more than a third of all autistic children in the USA are on prozac is anybody without a financial in Neuropharm collecting the data?

  7. Mike –
    I wrote about the Neuropharm trials a while back, expressing some hope as well as some concern. What was interesting is some of the comments I received. Feel free to take a look.
    http://onedadsopinion.blogspot.com/2007/07/drug-trial-for-fluoxetine.html

    Thanks for touching back on this. I think you are expressing the same thing I and some of the commenters have – in and of itself, if Prozac helps an autstic person feel better, great. If Prozac develops into a drug aggressively marketed to parents of autistic children and takes on the cloak of a “cure”, no good can come of that.

  8. Thanks Steve,

    that is a very thoughtful post and an interesting discussion. I particularly liked the point about medication that makes people feel better in themselves rather than suppressing behaviours without regard to how this affects the person taking the medication.

  9. Amanda is right…the data on serotonin levels and how anti-depressants work (and their efficacy) isn’t as solid or convincing as many people think. There’s been a lot of public misinformation on the issue.

    I agree with Mr. Stanton that we should focus on eliminating the sources of stress for autistic children rather than pumping them full of drugs. However, it’s good to hear that the UK has guidelines preventing kids from being put on Prozac without trying psychotherapy first.

  10. Mike,

    A recent report from the CDC indicates that the US suicide rates have gone up significantly since the “black box” warning was placed on SSRI’s.

    Interestingly, and possibly related, the use of SSRI’s went down in that period of time.

    I think that the blanket use of any drug for any disorder, disease or disability is a bad idea (with the possible exception of the blanket use of tetracycline in people exposed to The Plague). This goes triply so for a disorder/disability like autism, which has a myriad of different degrees and subtleties.

    I’m also more than a bit concerned about the idea of placing children on a drug for a prolonged period without some sort of study showing that it is safe in children over the long term. I fear that is what will happen to autistic children.

    In depression (at least in the US), it is pretty standard to stop medication after a year to see if the depression has gone into remission (or whatever depression does when it is out of town). In autism, it is likely that the medication will be given indefinitely, with unknown consequences.

    Prometheus

  11. That is interesting, Prometheus.

    Did they break down the figures by age? As I recall the original black box warning only applied to under 18s as there was no increase in suicidality among adults and a decrease in suicidality amongst the elderly when using prozac.

  12. Mike,

    I haven’t been able to get to the CDC figures – it’s all from an AP report, but here’s what AP said:

    The suicide rate among young people – ages 10 to 24 – rose 8% from 2003 to 2004 after years of declining.

    The rate for teenage girls rose the most – 32% for girls 15 – 19 and 76% for girls 10 – 14 (the numbers in the younger girls are very small and so susceptible to random events).

    Prescriptions of SSRI’s dropped in 2003 following the “black box” warning about using SSRI’s in teens and children.

    It’s still just an association at this point, but it is suggestive and the CDC is investigating.

    Prometheus

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