Antidepressants and autism

Newsweek magazine recently published a very provocative article on antidepressants based on research in The Journal of the American Medical Association in January - www.newsweek.com/id/232781. That research presented evidence indicating that popular antidepressants are no more effective than a placebo, with the strong suggestion that it is the patient's own expectation of improvement that lifts the depression. The article does state that the antidepressants can be effective in patients with severe depression and it does not advocate that patients stop taking their medications. Naturally, there was a strong response to the Newsweek's article and the media picking up on the simplistic idea that antidepressants are as effective as a sugar pill - and a whole lot less expensive. The Psychiatric Times responded with a lengthy discourse on the Newsweek article and the research itself. www.psychiatrictimes.com/home/content/article/10168/1520550

I thought about the experiences of our students with autism who have been given antidepressants and how a placebo effect would not necessarily be in play. Our students, being on the lower end of the spectrum, typically do not have the self awareness to realize that they may be depressed or an understanding of the purpose of the medications. Since the effectiveness takes weeks to ascertain, it would seem to stand to reason that either the medication works or not - and that is the conundrum I see. What we usually observe in those first six weeks or so of the medication trial, are students much calmer and happier - a time when supposedly we should not be seeing anything. After this initial period, we then see an increase in agitation and anxiety. At that point, there is often an increase in the dosage, which just exaggerates the side effects now being exhibited. While the antidepressant might not alleviate the behavior problems for which it was initially prescribed, there clearly is some kind of effectiveness, at least in the beginning. So something is happening. Perhaps a better reflection on the effectiveness of antidepressants on mood disorders or depression might be to track the response of people with autism, who won't have the distraction of a placebo effect.

Wakefield and the MMR vaccine

Last week the British General Medical Council (GMC) retracted the Lancet paper by Andrew Wakefield, M.D. that had stated there was a link between the MMR vaccine and autism. http://www.guardian.co.uk/society/2010/jan/28/andrew-wakefield-mmr-vaccine

According to the GMC, Wakefield's research had been done unethically and for profit, and this was the reason for the retraction, NOT vindication of the MMR vaccine. Although vaccines definitely are necessary for the general public health, the intense vaccine schedule infants and toddlers are recommended should be researched much more before assuming all are safe. It seems to defy reason that a one day old infant should receive the Hepatitis B vaccine before leaving the hospital. And the burden of so many vaccines on such immature immune systems must be more carefully calculated. It makes much more sense to me to spread the vaccines out over time, and not load them together. As far as I am concerned, the jury is still out on the culpability of vaccines - perhaps just the overload, if not the vaccines themselves.