Therapeutic effects of antidepressants for global improvement and subdomain symptoms of autism spectrum disorder: a systematic review and meta-analysis.

Shun-Chin Liang Cheuk-Kwan Sun Hsin-Yi Fan Weilun Chung Ruu-Fen Tzang Kuo-Chuan Hung Hsien-Jane Chiu Yu-Shian Cheng Pin-Yang Yeh

J Psychiatry Neurosci

From the Department of Management Centre, Jianan Psychiatric Centre, Ministry Of Health and Welfare, Tainan, Taiwan (Liang); the Centre for General Education, University of Kun Shan, Tainan, Taiwan (Liang); the Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan (Sun); the School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan (Sun); the Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Taiwan (Fan, Chung, Cheng); the Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan (Tzang); the Department of Anesthesiology, Chi Mei Medical Centre, Tainan, Taiwan (Hung); the Taoyuan Psychiatric Centre, Ministry of Health and Welfare, Taoyuan City, Taiwan (Chiu); the Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei City, Taiwan (Chiu); the Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung City, Taiwan (Cheng); the Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan (Yeh); Clinical Psychology Center, Asia University Hospital, Taichung, Taiwan (Yeh)

Published: August 2022

Background: No established pharmacological treatment is available for the core symptoms of autism spectrum disorder (ASD). This study aimed at investigating the efficacy of antidepressants for the core and associated symptoms of ASD.

Methods: We searched PubMed, Embase, ClinicalKey, Cochrane CENTRAL, ScienceDirect, Web of Science and ClinicalTrials.gov using the keywords "ASD" and "antidepressants." We searched from database inception to June 2021 for randomized controlled trials of antidepressant use in patients with ASD. We calculated pooled effect sizes based on a random-effects model.

Results: Analysis of 16 studies with 899 participants showed improvements in restricted and repetitive behaviours (effect size = 0.27) and global symptoms (effect size = 1.0) in patients with ASD taking antidepressants versus those taking placebos ( ≤ 0.01). We found no differences between the 2 groups ( ≥ 0.36) in terms of dropout rate (odds ratio [OR] = 1.17) or rate of study discontinuation because of adverse events (OR = 1.05). We also noted improvements in irritability and hyperactivity in the antidepressant group (Hedges = 0.33 and 0.22, respectively, both < 0.03). Subgroup analyses showed significant effects of medication type (i.e., clomipramine was better than SSRIs) and age (antidepressants were more effective in adults than in children or adolescents) on both restricted and repetitive behaviours and global improvement ( < 0.05). Meta-regression demonstrated that better therapeutic effects were associated with lower symptom severity and older age.

Limitations: The small effect sizes and variations in treatment response that we found warrant further study.

Conclusion: Our results supported the effectiveness of antidepressants for global symptoms and symptom subdomains of ASD, with tolerable adverse effects. Low symptom severity and adulthood were associated with better outcomes.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9377548	PMC
http://dx.doi.org/10.1503/jpn.210191	DOI Listing

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