A literature analysis of 20 studies showed an increased risk of type 2 diabetes in individuals taking antidepressants, (Virginio Salvi, Ilaria Grua, Giancarlo Cerveri, Claudio Mencacci, and Francesco Barone-Adesi, "The Risk of New-onset Diabetes in Antidepressant Users- A Systemic Review and Meta-analysis, PLoS One 12, no. 7 (July 2017): e0182088, doi:10.1371/journal.pone.0182088). According to another study of 199,608 youth aged 5-20 years, taking antidepressants at least 150 days almost doubled the risk of type 2 diabetes, (Mehmet Burcu, Julie M. Zito, Daniel J. Safer, Laurence S. Magder, Susan dosReis, Fadia T. Shaya, and Geoffrey L. Rosenthal, "Association of Antidepressant Medications With Incident Type 2 Diabetes among Medicaid-Insured Youths," JAMA Pediatrics 171, no. 12 (October 2017): 1200-1207, doi:10.1001/jamapediatrics.2017.2896. Antidepressants are used for other reasons besides depression, such as anxiety and obsessive compulsive behaviors. As discussed in my book, diabetes can be harmful to the brain, cause insomnia and changes in blood sugars are linked directly to anger, anxiety, sadness and frustration, which may increase problem behaviors in autism or other individuals with communication impairments. Furthermore, my book discussed a literature analysis which showed one class of antidepressants, selective serotonin reuptake inhibitors had limited utility in autism. This is another reason why we need more availability of applied behavior analysis, psychotherapies and use diet and exercise to decrease the use of medication.
I'VE BEEN CENSORED
I have recently been banned on a local Facebook page from posting that I am giving a lecture on January 31, 2018 at the Elija School on treatments for dangerous behaviors, due to some of my views, which by some are considered controversial. I was also accused of supporting "putative" treatment, even after I informed the administrator about my brother Stuart, who now has osteoporosis, multiple fractures and may be crippled for life, after taking years of medications which weaken bones to control his behavior and that this would not have occurred if he was at the Judge Rotenberg Center.
At first I felt hurt, that this person instead of being judgmental, should be grateful not to ever have to go to sleep, or not being able to sleep at night, worrying if her child would be dead in the morning due to a life-threatening behavior, as my family had to go through.
I always feel that if it isn't one of my brothers (Stuart and Matthew) I have to fight a battle for effective treatment, then it is my daughter, Talia. I sometimes joke that I became a doctor, not to take nice trips or go out to eat, but to pay for autism treatment for her. When I had no school bus, I drove her to school from Queens, dropped her off at 9AM in Long Island, then went to Manhattan to do my autism research fellowship, and got home at 8:30 PM. Even though my husband is a lawyer and I am a doctor, we have worn second hand clothes and my husband collected cans at work. The fear is always there, that I will lose a hearing, and work like I did in residency training again to pay for her school and other therapy expenses. I do not understand how someone can think I would send my brother Matthew to a school to be abused.
Matthew is obsessed with and collects maps. Every time he calls the family he asks us for maps. At school when he behaves well, he gets 15 minute breaks to look at his maps. Recently JRC had Santa come. My brother excitedly told me that Santa gave him a new NYC map and the 2018 World Atlas. So thoughtful! He works a job, such a contrast to Stuart. I wrote my book because I felt I had to do everything I could for my family and I am disgusted with the status quo. While some individuals need psychiatric medication, for others, including Stuart in the present and Matthew in the past, it has become a chemical prison. I certainly could have been spending my time earning money seeing patients instead.
When I gave continuing medical education lectures on autism diagnosis and treatment in communist China, I never was censored. What irony I am censored here in the US!
What really infuriated me, was when the same person who censored me, considering me controversial, posted something from the Autism Self Advocacy Network, which promotes facilitated communication stating it "should be more widely available" despite the fact that it has been scientifically disproven and innocent parents have been jailed over this. I can't imagine what it must be like to be in prison, being unable to care for your child with autism. The Autism Self Advocacy Network also states "research suggests that the evidence base for ABA is relatively weak," despite thousands of published studies. Although I am considered to be controversial, I do not endorse any scientifically disproven treatments that have put innocent people in prison, and whatever I recommend is based on research evidence. My book has 361 footnotes.
I feel the bigger problem is a relection of today's society as a whole. Instead of civil debate and dialogue, we become self-righteous, close minded and judgmental. We need to listen to each other, not silence each other.
Autism, Diet and Behaviors
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.