Lack of efficacy of citalopram in children with autism spectrum disorders and high levels of repetitive behavior: Citalopram ineffective in children with autism

Bryan H. King, Eric Hollander, Linmarie Sikich, James T. McCracken, Lawrence Scahill, Joel D. Bregman, Craig L. Donnelly, Evdokia Anagnostou, Kimberly Dukes, Lisa Sullivan, Deborah Hirtz, Ann Wagner, Louise Ritz

Research output: Contribution to journalArticlepeer-review

300 Scopus citations

Abstract

Context: Selective serotonin reuptake inhibitors are widely prescribed for children with autism spectrum disorders. Objectives: To determine the efficacy and safety of citalopram hydrobromide therapy for repetitive behavior in children with autism spectrum disorders. Design: National Institutes of Health-sponsored randomized controlled trial. Setting: Six academic centers, including Mount Sinai School of Medicine, North Shore-Long Island Jewish Health System, University of North Carolina at Chapel Hill, University of California at Los Angeles, Yale University, and Dartmouth Medical School. Participants: Onehundred forty-nine volunteers 5 to 17 years old (mean[SD] age, 9.4 [3.1] years) were randomized to receive citalopram (n=73) or placebo (n=76). Participants had autistic spectrum disorders, Asperger disorder, or pervasive developmental disorder, not otherwise specified; had illness severity ratings of at least moderate on the Clinical Global Impressions, Severity of Illness Scale; and scored at least moderate on compulsive behaviors measured with the Children's Yale-Brown Obsessive Compulsive Scales modified for pervasive developmental disorders. Interventions: Twelve weeks of citalopram hydrobromide (10 mg/5 mL) or placebo. The mean (SD) maximum dosage of citalopram hydrobromide was 16.5 (6.5) mg/d by mouth (maximum, 20 mg/d). Main Outcome Measures: Positive response was defined by a score of much improved or very much improved on the Clinical Global Impressions, Improvement subscale. An important secondary outcome was the score on the Children's Yale-Brown Obsessive Compulsive Scales modified for pervasive developmental disorders. Adverse events were systematically elicited using the Safety Monitoring Uniform Report Form. Results: There was no significant difference in the rate of positive response on the Clinical Global Impressions, Improvement subscale between the citalopram-treated group (32.9%) and the placebo group (34.2%) (relative risk, 0.96; 95% confidence interval, 0.61-1.51; P>.99). There was no difference in score reductiononthe Children's Yale-Brown Obsessive Compulsive Scales modified for pervasive developmental disorders from baseline (mean [SD], -2.0 [3.4] points for the citalopram-treated group and -1.9[2.5] points for the placebo group; P=.81). Citalopram use was significantly more likely to be associated with adverse events, particularly increased energy level, impulsiveness, decreased concentration, hyperactivity, stereotypy, diarrhea, insomnia, and dry skin or pruritus. Conclusion: Results of this trial do not support the use of citalopram for the treatment of repetitive behavior in children and adolescents with autism spectrum disorders. Trial Registration: clinicaltrials.gov Identifier: NCT00086645.

Original languageEnglish (US)
Pages (from-to)583-590
Number of pages8
JournalArchives of General Psychiatry
Volume66
Issue number6
DOIs
StatePublished - Jun 2009
Externally publishedYes

ASJC Scopus subject areas

  • Arts and Humanities (miscellaneous)
  • Psychiatry and Mental health

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