SPARK is the US's largest autism study - more than 100k families. Its goal is to accelerate research and improve our understanding of Autism to better the lives of those affected. SPARK celebrates its 5th anniversary and is dedicated to discovering the causes and treatment of ASD. https://sparkforautism.org/5years/
This article is the second in a series on depression in autism patients. Part 1 is Diagnosing Depression among People with Autism.
Thanks to research, we know more about depression in children and adults with Autism than we used to. Whereas scientists have studied the rates of depression, risk factors, and ways to diagnose it in people on the spectrum, we know far less about how treatments traditionally used on the general population work for those with Autism.
Dr Katherine Gotham, Rowan University psychologist, says no gold standard exists for treating depression in autism patients.
Gotham and others noted that there had been little research on antidepressants to treat depression in autism patients.2 This was as of September 2020.
People living with Autism are four times more likely than the general population to experience depression in their lifetime. A third of autistic adults and 8% of youth have experienced depression.3 Suicide is a higher risk for those with Autism. Studies show that people with Autism are more likely to have suicidal thoughts or plans than the general population. However, the exact amount varies from one study to another.
However, this does not mean that autism-related depression is not being successfully treated for children, teens and adults. Doctors often rely on clinical experience when treating autism patients.
Robert Wisner–Carlson, M.D., psychiatrist, says that people with Autism can respond to traditional depression treatments. Wisner-Carlson heads the Autism and Neurodevelopmental Outpatient Program at Sheppard Pratt, a Maryland mental and behavioral health system. These treatments could include:
Antidepressant medicine. According to University of North Carolina-Chapel Hill psychiatrists, one type of SSRI, Selective Serotonin Reuptake Inhibitors, or SSRIs "are generally safe and useful" for Autism.9 SSRIs include Prozac, Zoloft and others.
Counselling
Cognitive behavioural therapy is a method that helps people change their negative thoughts.
Mindfulness therapy is a form of mindfulness that involves relaxation and breathing techniques.
People with Autism may need to modify their treatment. This is because they are more likely to experience side effects such as irritable or impulsive behaviour, trouble sleeping and difficulty sleeping. This is especially true for children and teens.
These drugs can also lead to suicidal thoughts, behaviours, and worsening mood in people with bipolar disorder. According to an article in Pediatrics about anxiety, these medications should be "prescribed cautiously in youths with autism, with close supervision."
Mental health professionals will assess depressed patients and determine if they have bipolar disorder. This is a condition that causes periods of depression or mania. Evidence suggests that bipolar disorder incidence may be higher among people with Autism. Also, it would help to consider whether the person's periods meet or partially meet the criteria for bipolar disorder. Wisner-Carlson asks, "Is there a family history of bipolar disorder?" Bipolar depression can be treated with different medications than major depression.
Combining Treatments to Treat Depression
Janet says that her struggle with depression began in childhood. Janet, an autistic participant in the SPARK autism study, says that although she doesn't believe she's ever lived a single day without experiencing depression, she has found coping strategies. Janet describes how structure and a goal help her cope. Janet was diagnosed with depression ten years ago and prescribed an SSRI. She adds, "I believe that you shouldn't take any type of medication for depression without combining it with talk therapy, cognitive behavioral therapy, or something similar."
Treatments for Depression That Do Not Require Medication
Non-drug therapies are being explored more than medication. However, many studies do not cover a wide range of individuals on the spectrum.
Cognitive behavioral therapy (or CBT) is a treatment that helps patients change their negative thoughts and behavior. This therapy can help improve mood and coping abilities. These ideas are suggested by Michelle Garnett and Tony Attwood, clinical psychologists.
Our perceptions and thoughts about people, events, and situations influence our behavior.
The consequences of our actions impact how often we repeat them.
13 We can monitor our thoughts and behaviors and make changes over time.
Researchers have looked at ways to modify CBT to help people with Autism. These modifications include concrete language and images and incorporate the patient's interests.
One study from Australia found that CBT programs called "think well, feel well and be healthy" reduced symptoms of depression in young adults and teens with mild Autism. A study in Australia showed that CBT helped to reduce symptoms of depression and stress in teenagers and young adults with soft forms of Autism. 15
Mindfulness Therapy and Autism
A study of autistic adults from the Netherlands found that mindfulness therapy was effective in helping them to cope with Autism. This approach taught 20 adults to be present at the moment and to accept their experiences. They also learned to meditate and did breathing exercises for 40-60 minutes daily. An identical group of 21 adults with Autism was not treated and served as a comparison. 16
The therapy group had a lower incidence of anxiety and depression than the comparison group.
In that study, the intelligence scores of adults were in the average range. Many studies on mindfulness and CBT do not include people with intellectual disabilities or limited speech. It has yet to be discovered how these therapies would work with them.
Researchers have called for increased research on medication for depression to benefit people with Autism. Two UNC psychiatrists stated that studies of medicines for depression should be focused on those who are least verbal as they are less likely than others to benefit from psychological interventions. 9
Additional Resources
The National Suicide Prevention Lifeline offers confidential, free support 24 hours daily at 1-800-273-8255 or online chat. This lifeline provides information and resources for professionals and prevention and crisis resources.
The Academy of Cognitive and Behavioral Therapies can help you find a cognitive therapist near you.
The National Association for the Dually Diagnosed for people with intellectual/developmental disabilities and mental health needs.
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