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Depression has been identified as one of the largest public health burdens in the United States and major depressive disorder is considered one of the most common co-occurring disorders in autism.1 The common symptoms of depression include irritability, depressed mood, apathy, sleep disturbance, appetite disturbance, and self-injurious behavior linked to suicidal ideation.
The co-occurrence of depression in persons with autism spectrum disorders (ASD) can significantly and negatively affect quality of life (Magnuson & Constantino, 2011)2 and limit the success of other treatments targeting ASD symptoms – including benefits from therapeutic interventions and participation in educational, vocational, and community activities.
Recent studies report that over a third of adolescents and adults with ASD meet criteria for at least one episode of major depressive disorder during their lifetime.3 Another study of children with ASD found that 10% of children met full DSM-IV criteria for major depressive disorder and an additional 14% reported signifiicant symptoms of depression, but fell just short of meeting official criteria.
Accurate, reliable diagnosis of depression is important and may require referral to specialists such as a psychiatrist, psychologist, or master’s level mental health professional experienced in working with ASD. One of the challenges of accurate diagnosis of depression is related to the communication limitations of many individuals with ASD. The symptoms of depression may also present differently in individuals with ASD – while the most essential features of major depression in the general population are change in mood and loss of interest, the most common presenting symptoms of depression in individuals with ASD may be significantly increased agitation, self-injury, and temper outbursts (Sovner & Hurley, 1982b4, Lainhart & Folstein, 19945).
Despite these findings, limited research has been conducted on the treatment of depression in ASD, particularly on teens and adults with ASD. There has been no published systematic drug trial for major depressive disorder in persons with ASD and only limited research documenting the concurrence of depressive disorders in these individuals. The limited research on the psychopharmacology of ASD has primarily focused on irritability [aggression, self-injury and severe tantrums] (Marcus et al., 20096; RUPP Autism Network, 20027), motor hyperactivity and inattention (RUPP Autism Network, 20058), and interfering repetitive behavior (King et al., 20099).
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