19705
Citalopram Treatment of Young Children with Autism Spectrum Disorder (ASD): Correlation with Maternal History of Depression
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.