Bailey’s mother in law, Susan, opened her arms wide as soon as she saw her. As Bailey ran into them, Susan asked, “How is he doing?” Pulling back, Bailey shook her head in discouragement, “I can’t get through, I don’t know how to reach him”.
Her son had been suffering through a bout of severe depression. Bailey, and the rest of the family were beginning to feel desperate. Conner’s autism complicated the situation, his selective mutism prevented him from speaking to professionals, but all Bailey knew was that they had to get help.
Knowing medication might be an option was tempting, but how autism and antidepressants interact was a mystery to her. Nevertheless, she decided to make the phone call that would save his life.
This subject is near and dear to so many of us, especially in the autism community. Let’s look at this issue, how it can affect families touched by autism, and what can be done to help.
Autism and mental illness
Studies show people with autism are at an increased risk of experiencing depression and anxiety. In fact, according to an article by Victor Ruggieri, people with autism are actually: “four times more likely to develop depression than the general population, it is even considered as the most common mental health condition in people with autism spectrum disorders (ASD).”
This is a serious issue. Part of what makes the process of diagnosing and coming up with an appropriate plan to treat depression in those with autism, is that it can present differently.
Ruggieri continues: “One of the challenges is to recognize the manifestations related to depression in people with ASD, in whom, in general, it is expressed differently in relation to those with typical development. Depression in people with autism can manifest itself with restlessness and insomnia and not with feelings of sadness, so it is essential to be attentive and not justify all behavioral problems to autism.
“Young adults with ASD have higher baseline levels of almost all the depression characteristics listed in the DSM-5, which can lead to overdiagnosis or underreporting of depression. On the other hand, adults with autism have an increased risk of experiencing suicidal thoughts, planning suicide, carrying it out and even dying from suicide. Many of them have a history of depression, harassment and loneliness.”
It is important for us to research, learn about, and watch for signs and symptoms of depression in our loved one with autism spectrum disorder. Depression and anxiety are powerful things. Knowing when and how to help is crucial—and can mean the difference between life and death.
What are some risk factors of depression and other mental health issues with ASD?
To explore risks for depression for someone with autism, we can begin before the individual is even conceived. We know that depression can have genetic factors. If someone’s parent, or both the mother and father, have a history of depression, their risk also goes up for developing depression disorders (DD) in their life.
One study titled Genetics Factors in Major Depression Disease states:”Family and twin studies have demonstrated that the contribution of genetic factors to the risk of the onset of DDs is quite large.”
After conception, maternal depression can play a part in fetal developmental disorders (autism spectrum disorder, ADHD, and others), and future development of depression for that child.
For instance, some believe that if a pregnant person takes an antidepressant during their pregnancy, the risk of autism spectrum disorder is higher (depending on the stage of pregnancy and duration of exposure to selective serotonin reuptake inhibitors and the like). So, the fetus’ risk of developing depression would be two-fold in that particular circumstance, both genetics, and their risk of autism spectrum disorders, which we know is associated with a higher risk of depression in itself.
However, when determining the risks of maternal antidepressant use, the life and wellbeing of the pregnant person also must be taken into consideration. Each person is different, sometimes the benefits outweigh the risks.
Some things to consider for maternal antidepressant exposure would be:
- prenatal antidepressant exposure
- risks of not taking them
- trimester exposure
- neonatal exposure
- risk to the fetus
A doctor or mental health professional is needed to help determine what is best for each person and their family. There is no one-size-fits-all treatment, but there are options.
What are some effects of depression and anxiety disorder on someone’s life?
Depression and anxiety disorders can affect a person’s entire life. Financial relationships, relationship to self, and relationship with others can all be impacted. Most often the effects come full circle.
For example, a person who is depressed may struggle with self worth. This can make them feel as if they have nothing of value to offer others, make them hesitant to work or be properly compensated for their labor, and isolate them from friends or family. This can cause more feelings of depression and low self esteem, further separating them from themselves, their work, and their loved ones.
The risk of suicide is higher in people with ASD. “The combination of depression with additional risk factors may particularly predispose people with ASD to suicidality. Among adults with ASD, it was found that those who have depression have higher cognitive abilities and higher social skills, which suggests that being more aware of own challenges, such as difficulties interacting socially, can lead to a higher risk of depression.” (Sterling et al. 2008).
Another study (Kraper et al. 2017) examined the relationship between adaptive functioning described as “real-life skills”, intelligence, and associated psychiatric concerns among people with ASD. The results indicate that poor adaptive functioning can lead to greater psychiatric concerns, such as depression. Moreover, there is a higher risk for depression or other mental conditions among those individuals with ASD with the largest gap between intelligence and adaptive functioning, indicating that high cognitive abilities cannot be considered as protective factors for mental health concerns in ASD (Kraper et al. 2017).
Because people with ASD are at a higher risk for more severe depression resulting in suicide, getting help is imperative. The presence of comorbid conditions can compound the risks. Enlisting the help of a mental health professional is the key to determining the proper antidepressant treatment.
Autism and antidepressants
Antidepressant treatment can include medications. Medications used to treat depression are most often selective serotonin reuptake inhibitors (SSRIs),
The availability of selective serotonin reuptake inhibitors is extremely limited when used for children. In fact, only one on the market currently is approved by the FDA to be used in adolescence. In adults, the number of choices for selective serotonin reuptake inhibitors is higher.
However, the presence of autism spectrum disorders can add confounding factors, as does the existence of comorbid conditions. Each person is different, each set of variables is also different. Therefore, a selective serotonin reuptake inhibitor is rarely the only prescribed treatment.
How does antidepressant exposure affect ASD?
In addition to the possible relief of depression, SSRIs can reduce symptoms of ASD. According to the NHA they may:
- reduce the frequency and intensity of repetitive behaviors
- decrease anxiety, irritability, tantrums, and aggressive behavior; and
- improve eye contact.
What are some side effects of antidepressant medication?
The NHA also provides a list of possible side effects of antidepressant exposure. They include:
Common side effects of selective serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs) can include:
- feeling agitated, shaky or anxious
- feeling and being sick
- indigestion and stomach aches
- diarrhea or constipation
- loss of appetite
- dizziness
- not sleeping well (insomnia), or feeling very sleepy
- headaches
- loss of libido (reduced sex drive)
- difficulties achieving orgasm during sex or masturbation
- difficulties obtaining or maintaining an erection (erectile dysfunction)
These side effects should improve within a few weeks, although some can occasionally persist.
Tricyclic antidepressants (TCAs)
Common side effects of TCAs can include:
- dry mouth
- slight blurring of vision
- constipation
- problems passing urine
- drowsiness
- dizziness
- weight gain
- excessive sweating (especially at night)
- heart rhythm problems (arrhythmia), such as noticeable palpitations or a fast heartbeat (tachycardia)
The side effects should ease after a couple of weeks as your body begins to get used to the medicine. These would be in addition to the withdrawal symptoms one might experience if the medication is not taken properly or regularly—another consideration.
Can autistic adults benefit from antidepressant medications?
Since someone over the age of 18 has more FDA approved choices for medication, they may benefit from antidepressant exposure. Again, it is up to the individual and their doctor to determine what is right for them.
One thing to note about antidepressant use, is that even if someone continues to use these medications for the duration of their lifetime, they should not be looked upon as a “cure”. Antidepressant medication is designed to be a part of a host of aids that work together to help a person live their life to the fullest.
What additional treatments are available besides selective serotonin reuptake inhibitors?
Treatment for depression doesn’t always include medications. Therapies are available. Also, it is important to note that in patients who have depression and ASD, therapies such as occupational therapy, physical therapy, and psychotherapy can be a great combination.
Autism’s challenges can include social and communication difficulties making talk therapy difficult. The addition of the other therapies can help the patient overcome those challenges and open up their options for getting help without, or in addition to, medication.
If depression symptoms disappear, or ASD symptoms are alleviated by these medications, the temptation could be to depend on them fully. More often than not, depression, anxiety, and poor coping skills can be better served by using the medication as a step up the ladder of treatment. With time, learning new strategies, working through issues in therapy, and putting into practice what you have learned throughout may eliminate the need for medications such as these.
Resources
As you walk through this journey with your loved one, I hope you find encouragement that you, and they, are not alone. In addition to following the advice from licensed professionals, I would like to offer some ideas for how you can help yourself, or a loved one manage depression. Here are some (personally recommended) resources you can reach for:
US: SAMHS
UK: NHS
Books:
- Overcoming Anxiety and Depression on the Autism Spectrum: A Self-help Guide Using CBT
- Lucky G and the Melancholy Quokka: How Play Therapy can Help Children with Depression
- Listening to My Body: A guide to helping kids understand the connection between their sensations (what the heck are those?) and feelings so that they can get better at figuring out what they need
- Pockets Full of Rocks: Daddy Talks About Depression
- Where Hope Begins: Decoding Depression for You and Your Loved Ones
Summing-up
No one wants to see their loved one struggling with depression. I will be honest, my family and myself have a long history with depression. I have walked a similar road to our friend Bailey from above with my loved ones—including my own child.
Antidepressants can be helpful. They are often an effective tool to give people hope and assistance in dealing with depression. They may even help with ASD symptoms.
They do not come without risks, and should always be used in conjunction with other services. If your loved one with autism is walking through depression, reach out. There is help available!
References:
Ruggieri V. (2020). Autismo, depresión y riesgo de suicidio [Autism, depression and risk of suicide]. Medicina, 80 Suppl 2, 12–16.
Shadrina, M., Bondarenko, E. A., & Slominsky, P. A. (2018). Genetics Factors in Major Depression Disease. Frontiers in psychiatry, 9, 334. https://doi.org/10.3389/fpsyt.2018.00334
Costa, A. P., Loor, C., & Steffgen, G. (2020). Suicidality in Adults with Autism Spectrum Disorder: The Role of Depressive Symptomatology, Alexithymia, and Antidepressants. Journal of autism and developmental disorders, 50(10), 3585–3597. https://doi.org/10.1007/s10803-020-04433-3
