Identifying a mood disorder, such as depression, in individuals with autism spectrum disorder may be challenging.
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 significant 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).
- Leyfer, OT, Folstein, SE, Bacalman, S, Davis, NO, Dinh, E, Morgan, J, Tager-Flusber, H, Lainhart, J. Comorbid Psychiatric Disorders in Children with Autism: interview development and rates of disorder. J Autism Dev Disord (2006) 36:849-861.
- Magnuson KM, Constantino JN. Characterization of depression in children with autism spectrum disorders. J Dev Behav Pediatr 32:332-340, 2011.
- Lainhart JE, Folstein SE. Affective disorders in people with autism: a review of published cases. J Autism Dev Disord 24:587-601, 1994.
- Sovner, R., & Hurley, A.D. (1982b). Diagnosing mania in the mentally retarded. Psychiatric Aspects of Mental Retardation Newsletter, 1, 10-12.
- Lainhart, J.E., & Folstein, S.E. (1994). Affective disorders in people with autism: a review of published cases. Journal of Autism Developmental and Disorders, 24, 587-601.
- Marcus RN, Owen R, Kamen L, Manos G, McQuade RD, Carson WH, Aman MG. A placebo-controlled, fixed-dose study of aripiprazole in children and adolescents with irritability associated with autistic disorder. J Am Acad Child Adolesc Psychiatry 48(10):1110-1119, 2009.
- Research Units on Pediatric Psychopharmacology Autism Network. Risperidone in children with autism and serious behavioral problems. N Engl J Med 347(5):314-321, 2002.
- Research Units on Pediatric Psychopharmacology Autism Network. Randomized, controlled, crossover trial of methylphenidate in pervasive developmental disorder with hyperactivity. Arch Gen Psychiatry 62(11):1266-1274, 2005.
- King BH, Hollander E, Sikich L, McCracken JT, Scahill L, Bregman JD, Donnelly CL, Anagnostou E, Dukes K, Sullivan K, Hirtz D, Wagner A, Ritz L. Lack of efficacy of citalopram in children with autism spectrum disorders and high levels of repetitive behavior: citalopram ineffective in children with autism. Arch Gen Psychiatry 66(6):583-590, 2009.