Citalopram Treatment of Young Children with Autism Spectrum Disorder (ASD): Correlation with Maternal History of Depression

Friday, May 15, 2015: 11:30 AM-1:30 PM
Imperial Ballroom (Grand America Hotel)


Background:  Serotonin is essential for normal brain development in early childhood. Altered serotonin levels during early development are speculated to lead to abnormal brain circuitry and symptoms of autism spectrum disorder (ASD). Low plasma serotonin levels have been reported in children with ASD and their mothers and may be critical for early brain development.

Objectives: To report anecdotal clinical experience of behavioral improvements during treatment with low-dose citalopram in boys with a diagnosis of ASD, all of whom had a strong maternal and family history of depression.

Methods: Prospective treatment and followup of 8 boys with ASD who were treated with citalopram. All had a history of maternal depression, and 2 mothers received SSRIs during pregnancy. All had normal genetic/ metabolic testing. Citalopram was started at 0.5-1 mg/day and increased weekly by 0.5-1 mg/day as tolerated, avoiding overstimulation as the dose was increased; it was decreased to the previous level if the child showed increased excitation, difficulty with sleep or decreased appetite. Children were treated for up to 1 year and then citalopram was tapered in the same manner as it was started. Ohio Autism Clinical Impressions Scale – Improvement(OACIS-I) was used to evaluate improvement in behavior over time.

Results: Within 3 months of treatment all 8 patients were much improved on most subscales of the Autism Clinical Global Impression-Improvement (Autism CGI-I) scale. Two patients maintained developmental gains following discontinuation; 2 regressed during weaning and were restarted; 4 are still on initial treatment and doing well.  

Conclusions: Although citalopram has limited effects in older children with ASD, our experience suggests that it may be effective in promoting brain development in young children, especially in those with a maternal and family history of depression and treatment with SSRIs. There are likely to be specific differences in serotonin synthesis, transport or receptors in these families.