Depression in Young People with Autism Spectrum Disorder (ASD)

“Do teenagers with Asperger syndrome and level 1 autism usually suffer from depression? If so, why? And what should parents look for if they believe their teenager is becoming depressed?”

Unfortunately, depression does seem to be common among teens and adults with Asperger’s (AS) and High-Functioning Autism (HFA). Many of the same deficits that produce anxiety may work together to generate depression.

Serotonin functions are impaired in many teens with ASD, which suggests that depression and ASD is more likely. Also, the basic circuitry related to frontal lobe functions in depression is affected in some teens on the spectrum.
In addition, deficits in social relationships and responses that permit one to compensate for disappointment and frustration may fuel a vulnerability to depression. Furthermore, there is some genetic evidence suggesting that depression and social anxiety are more common among first-degree relatives of autistic teens.

Another important point is that young people with ASD who display affective and vocal monotony are at higher risk for having their ‘suicidal remarks’ minimized. Higher-functioning teens can make suicidal statements in a manner that suggests an off-hand remark without emotional impact, and as a result, their comments may not be taken seriously. 
When comments are made this way, parents – and even therapists – may underestimate them. In these “special needs” teens, the content of such comments may be more crucial than the emotional emphasis with which they are delivered.

Depressed autistic teens often have trouble concentrating or remembering things. Sometimes they are indecisive. It is very common for them to feel hopeless or to "beat up on themselves" by thinking negative thoughts about themselves. Thoughts of suicide are common. They may lose their interest in food and frequently lose weight. Less often, depression causes these teens to indulge in comfort eating and they gain weight. 
A change in sleep patterns often accompanies depression. They may have trouble getting a good night's sleep, or alternatively, they sleep much more than usual and have trouble getting out of bed.

Other symptoms may include the following:
  • decreased energy
  • tiredness
  • fatigue
  • lack of interest in the opposite sex
  • being listless and withdrawn
  • withdrawal from their normal social activities
  • spending an increasing amount of time alone
  • may avoid leaving the house
  • speech can be flat and uncommunicative
  • may be exhausted and feel like they're "dragging themselves around"
  • may use drugs or alcohol in an attempt to make themselves feel better

 The medications that are useful for depression in “typical” teens should be considered for teens with ASD who display symptoms of depression. However, since some features of depression and autism overlap, it is important to track that the changes in mood are a departure from baseline functioning. Therefore, the presence of social withdrawal in a teen on the spectrum should not be considered a symptom of depression unless there is an acute decline from that young person's baseline level of functioning. 
Also, the core symptoms of depression should arise together. Thus, the simultaneous appearance of symptoms (e.g., decreased energy, further withdrawal from interactions, irritability, loss of pleasure in activities, sadness, self-deprecating statements, sleep and appetite changes, etc.) would point to depression.

Medications that are useful for treatment of depression in teens with ASD are serotonin reuptake inhibitors. There are no medications that have been shown to be particularly more beneficial for depressive symptoms in these young people. Therefore, the decision as to which medications to use is determined by side-effect profiles, previous experience, and responses to these medications in other family members.
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