Antidepressan use and outcome in children with autism spectrum disorder: Retrospective chart review

OBJECTIVE: The aim of our study was to examine the efficacy of SSRI treatment, the type and frequency of side effects observed during SSRI treatment and the relationship between sociodemographic and clinical characteristics that could be associated with these conditions in children and adolescents with autism spectrum disorder (ASD) who have cooccuring psychiatric conditions such as anxiety disorder (AD), obsessive-compulsive disorder (OCD) and depressive disorder (DD). MATERIAL and METHODS: In this study, the files of children and adolescents with ASD who received SSRI treatment in our clinic were retrospectively scanned. 42 children and adolescents who met the inclusion criteria were included in the study. CGI-S / AE, SDQ, ABC, UKU scales were used at the start and during medication dosing. The relationships between SSRI efficacy-side effects and the sociodemographic characteristics, co-occuring disorder and comorbid diagnoses were evaluated. Statistical analyses were conducted with the SPSS 21.0 statistical software. RESULTS: In our study sample, co-occuring diagnoses were AD (n =16, 38.1%), OCD (n =14, 33.33%) and DD (n =12, 28.6%) according to the indication for SSRI use. When CGI-S scores before SSRI treatment and 3 months after the start were compared for each diagnoses, statistically significant decrease was detected. When the emotional and total subunit of SDQ scores before SSRI treatment and 3 months after the start were compared, a statistically significant decrease was found for the whole sample. 57.1% (n =24) of the cases experienced psychiatric side effects, 28.6% (n =12) developed behavioral activation, 42.9% (n=18) experienced autonomic side effects, and manic switch observed in 2.4% (n=1) of patients. UKU autonomic side effects were negatively correlated with ASD severity and positively correlated with the presence of a psychiatric disease in the mother (r2 =0.262, p =0.010). It was found that the higher verbalization skills were a predictor for developing behavioral activation (r2=0.203, p =0.011). According to the results of the UKU evaluation, it was determined that the drug was discontinued due to side effects in 21.4% (n =9) of the patients. CONCLUSION: Clinicians should be aware of possible side effects when they consider starting SSRIs in children and adolescents with ASD and should question the side effects during the follow-up process. Although the results of our study make several predictions about in which patient population what kind of side effects may develop, we recommend to question possible side effects in a standard way in all patients. Side effects encountered during psychopharmacological treatment are among the important causes of treatment non-compliance and failure. Starting SSRIs with low doses and slow titration, informing patients and their relatives at the beginning of the treatment, careful follow-up of the patient and correct management of side effects are important in terms of treatment compliance and success. KEY WORDS: ASD, SSRI, child, adolescent, side effect, activity, anxiety, depression, OCD