This story covers a study that adds to prior research. A quick PubMed search finds an astonishing lack of randomized clinical trials evaluating antidepressants for autism. Although the study is small, it is a randomized clinical trial and addresses a gap in the evidence.
We would have like to have seen:
Overall, though, nice job of reporting.
The autism community is active, motivated and passionate about finding treatment solutions for their children and themselves. There is a huge amount of debate about the benefits of medication and whether some forms of autism need be treated as a medical disorder at all.
It’s not that costs are high, it’s just that they weren’t discussed. The costs of Prozac are well known and could have been included in this story. Taking just one pill a day for 30 days would cost $214 through Drugstore.com.Prozac is generic at $10 for 3 months at one big box chain. There are also medical followup costs and possibly costs of managing adverse effects.
After explaining that the story was quite small and covered only a few months time, the story provides a quick summation of the benefits found in the study saying, “half of the participants taking Prozac had significant reductions in obsessive-compulsive symptoms, compared with 8% taking placebo.” But given the very small sample size, natural frequencies would have been more informative and less likely to be misinterpreted. Also, a bit more detail on what a “significant reduction” means in an autistic disorder would have been welcome.
The story does say that, “Side effects were mild to moderate and participants taking Prozac did not show increases in suicidal thoughts or ideas.” It could have noted, though, that 12 weeks may not be long enough for side effects to emerge.
We liked how the story put up high some of the basics of the study, that it was limited to 37 subjects, that they were “high-functioning autistic adults, mainly diagnosed with Asperger’s syndrome,” and that they were followed for 12 weeks. Even though it sometimes feels like boilerplate language, it would have been appropriate to emphasize how small and short-term was this study and that it needs to be replicated in a larger, longer-term study.
The story does not engage in disease mongering but it could have provided a little more detail about the differences between Asperger’s syndrome and other forms of autism.
The story briefly quotes another story in which Yale Child Study Center director Fred Volkmar commented on the study, indicating that more research was needed. We would have liked to have seen more independent voices helping readers understand whether there was anything new here. The story also says, “Hollander has previously received funding from pharmaceutical companies, but the current study was paid for by a grant from the Food and Drug Administration’s “orphan” drug program.”
Here’s where the story both excels and disappoints. It takes note of prior research on antidepressants and notes that the “only drugs approved to treat irritability and repetitive behaviors in autistic children are the atypical antipsychotics Risperdal (risperidone) and Abilify (aripiprazole), which tend to have more severe side effects than Prozac does.” What the story does not explain, though, is that Hollander himself has researched this exact topic and arrived at very similar conclusions, which may bolster his case in some ways and weaken it in others. In 2005, he found in the journal Neuropsychopharmacology that “Liquid fluoxetine in low doses is more effective than placebo in the treatment of repetitive behaviors and that “Limitations include small sample size”.
There was also no mention of the possibility of behavioral treatments.
The story makes it clear that Prozac is widely available and that other drugs are approved for use in autistic patients.
The novelty of the finding is at least implied. This small study increases the number of patients studied in randomized clinical trials by about 15% and it is in adults. With the exception of the earlier RCT published in Archives Gen Psy (N=149) – in children – there are just a handful of small studies on this topic.
The story does not rely on a press release.