As discussed in my book, depression in individuals with autism may be expressed with increased intensity of problem behaviors. A recent study showed significant improvement in depression with a Mediterranean-style diet, (Natalie Parletta, Dorota Zarnowiecki, Jihyun Cho, Amy Wilson, Svetlana Bogomolova, Anthony Villani, Catherine Itsiopoulos, et al., "A Mediterranean-style Dietary Interventions Supplemented with Fish Oil Improves Diet Quality and Randomized controlled Trial," Nutritional Neuroscience (Dec 7, 2017): published online, doi:10.1080/1028415X.2017.1411320). 152 adults were randomized to either a social group or diet. Over 80% of individuals in the study reported "extremely severe" depression. Depression and quality of life improved in the diet group 45% at three months versus 26.8% in the individuals who received the social group intervention. In the diet group 60% of individuals no longer experienced "extremely severe" depression and the improved mental health was sustained at six months. The improvement in depression was associated with and improvement in vegetable diversity and nuts. Other mental health improvements were associated with increased vegetable diversity and legumes. Individuals with autism often have very selective diets but these can be improved through applied behavior analysis. A better diet improves both physical and mental health.
Antidepressants and Seizure Risk Examined in a New Study
According to a newly published study, involving 10,002 subjects, antidepressant exposure was associated with an increased risk of seizures among individuals with major depressive disorder, (Chi-Shin Wu, Hsin-Yen Liu, Hui-Ju Tsai, and Shi-Kai Liu, "Seizure Risk Associated With Antidepressant Treatment Among Patients With Depressive Disorders: A Population-Based Case-Crossover Study," Journal of Clinical Psychiatry (October 2017): epub ahead of print, doi:10.4088/JCP.16m11377). The study was composed of individuals visiting the emergency department or being hospitalized. The risk of seizures were compared when individuals were on and off antidepressant medications. Antidepressants were associated with a 48% higher overall seizure risk, with the highest Wellbutrin (buproprion) which more than double increased the risk and selective serotonin reuptake inhibitors (SSRIs) which resulted in a 76% higher risk. The higher the doses were, the higher the seizure risks were. Elevated risks were also found for serotonin and norepinephrine reuptake inhibitors (SNRIs) and mirtazapine (Remeron). The highest risk was found for individuals aged 10 to 24 years.
As discussed in my book, up to 60% of individuals with autism who do not have clinical seizures, have subclinical seizures, (Sarah J. Spence and Mark, T. Schneider, "The Role of Epilepsy and Epileptiform EEGs in Autism Spectrum Disorders," Pediatric Research 65, no. 6 (June 2009): 599, doi:10.1203/01.pdr.0000352115.41382.65) placing them at a higher risk when some psychiatric medications are given, as happened to my brother Stuart, who never had seizures until he was on psychiatric medications.
We need to have other interventions available, such as applied behavior analysis, cognitive behavior therapy and exercise to treat depression.
Antipsychotics, my brother's foot fractures and neglect at his NY residence, part two
A few weeks ago, I wrote about my brother Stuart who fell at his residence and now has multiple foot fractures and that his residence did not notify my mother or myself, his legal guardians, and waiting two days to obtain medical attention. I also wrote about how he was on multiple antipsychotics over the years which can weaken bones.
Last week, both my daughters and I went to visit Stuart at his OPWDD funded agency residence. Stuart was sitting in a wheelchair, and he looked so old. I could not help but reflect how all those psychiatric medications for so many years took a large toll on his body. He had a bone mineral density scan, which as I suspected, showed he had weak bones, and this is despite that he always had lots of dairy in his diet. I know the weak bones are from all those years of antipsychotics. Most antipsychotics can weaken bones. He now spends his day on the computer watching YouTube. In the living room, there is a post on the wall with all the individuals who live in the residence and the goals they made for themselves. Stuart's section on goals was empty. The staff informed me he wanted no part in it. I offered to take him out to lunch, thinking I would push the wheelchair while my older daughter would hold the leash of the service dog for my younger daughter, Talia, who like my identical brothers, also has autism. Stuart did not want to go out to lunch, but stated he wanted to have his cheese sandwich at his residence instead. My older daughter wanted to buy Stuart a subway book, but he said he can only look at books when he is in my mother's car going to visit his twin Matthew at Judge Rotenberg Center in Massachusetts. He finally agreed he would keep a book on bridges at his residence, any my daughter bought one for him immediately. While Stuart sat in the wheelchair, Talia watered the plants and fed the fish. The staff told me that Stuart has never watered the plants or fed the fish.
I could not help but think that even though Talia is almost nonverbal and her IQ is about 20 points lower than Stuart's, that she functions so much better than him, that she is productive, that she was much more quality of life. She is so much happier. It is the ABA that Talia has, why Talia can do farm work as part of her school program at Elija, the ABA that my brother Matthew has at JRC, why Matthew can hold a paid job, that makes them function so well and have such a good quality of life, and not require psychiatric medication. It is the ABA which keeps them healthy. ABA is a public health issue.
Autism, Suicide Attempts and Exercise
Having an autism spectrum disorder is an independent risk factor for a suicide attempt according to a recent study, (Mu-Hong Chen, Tai-Long Pan, Wen-Hsuan Lan, Ju-Wei Hsu, Kai-Lin Huang, Tung-Ping Su, Cheng-Ta Li, et al., "Risk of Suicide Attempts Among Adolescents and Young Adults With Autism Spectrum Disorder: A Nationwide Longitudinal Follow-Up Study," Journal of Clinical Psychiatry (August 2017): epub ahead of print, doi:10.4088/JCP.16m11100). The study followed 5,618 adolescents ages 12 and up and young adults up to age 29. The risk for a suicide attempt for individuals with autism was 3.9% vs. 0.7 percent with follow up periods between two and ten years.
Risk factors for suicide include anxiety and depression. A literature analysis of 16 articles including 922 participants shows an improvement in anxiety symptoms not only in healthy individuals, but also individuals with physical or mental illness, Brett R. Gordon, Cillian P. McDowell, Mark Lyons, and Matthew P. Herring, "The Effects of Resistance Exercise Training on Anxiety: A Meta-Analysis and Meta-Regression Analysis of Randomized Controlled Trials," Sports Medicine (August 2017): epub ahead of print, doi:10.1007/s40279-017-0769-0). Furthermore, another study following 33,908 adults showed that exercising at least one hour per week could have prevented 12% future cases of depression, assuming the relationship is causal, (Samuel B. Harvey, Simon Overland, Stephani L. Hatch, Simon Wessely, Arnstein Mykletun, and Matthew Hotopf, "Exercise and the Prevention of Depression: Results of the HUNT Cohort Study," American Journal of Psychiatry, (October 2017): epub ahead of print, doi:10.1176/appi.ajp.2017.16111223).
Despite the mental health, cognitive and physical benefits of exercise, students often do not have physical therapy on their Individualized Education Programs, schools do not provide recess, and adults with developmental disabilities at day programs and residences are not exercising. We need applied behavior analysis programs to give individuals with developmental disabilities motivation to engage in physical activity. However, most programs for autism and other developmental disabilities lack adequate applied behavior analysis programs, even though it would have such a public health benefit.
Antipsychotics, my brother's foot fractures and neglect at his NY residence
Two weeks ago, on Friday night, while going to the bathroom, my brother Stuart fell and broke bones in his foot. Unlike his identical twin at JRC who has been off medication for 28 years and has a paid job, Stuart has taken numerous antipsychotic medications over the years which can weaken bones. Furthermore, due to a lack of an effective behavior plan my brother sometimes kicks the wall which also may have damaged his bones.
After he fell, he refused to go to the hospital. Despite the fact he has autism, intellectual disability and has been declared incompetent by a judge, the staff at the residence honored his decision not to receive any medical attention. The residence never notified my mother nor myself despite we are his legal guardians.
Two days later in the afternoon, my mother called to speak with him. My mother was told he was not available because he was at the doctor's office. We have now been informed that Stuart is likely to have arthritis for life, might require surgery later on, and also might be crippled for life. He is only 45 years old. Sadly, he is at what is considered one of the best agencies in NY, having received the designation as a "Compass Agency," by New York State, for its reportedly excellent service, https://opwdd.ny.gov/opwdd_services_supports/service_providers/compass_initiative/compass/agencies.
Last Sunday, I completed my fifth marathon and now I am thinking my brother will probably never be able to run again at all. New York State considers taking away preferred items as a consequence even for dangerous behaviors, even though it may stop the behavior from reoccurring and therefore not require medications. However, the true human rights abuse is giving medications with toxic side effects as a replacement for effective behavior plans.