Reboxetine Treatment for Autistic Spectrum Disorder of Pediatric Patients With Depressive and Inattentive/Hyperactive Symptoms: An Open-Label Trial

Background: Reboxetine is a norepinephrine reuptake inhibitor that may be useful in treating pediatric depression as well as attention-deficit/hyperactivity disorder (ADHD). Both are often comorbid with autistic spectrum disorder (ASD). We evaluated the effectiveness of reboxetine treatment in pediatric patients with ASD with symptoms of depression and ADHD. Method: Eleven adolescent patients with ASD (9 boys and 2 girls, aged 12.2 +/- 3.6 years) with depressive and ADHD symptoms were treated with reboxetine (maximal dose, 4 mg/d) in an open-label trial during a 12-week period. The severity of depressive and ADHD symptoms was assessed by the Child Depression Rating Scale (CDRS) and Attention-Deficit/Hyperactivity Disorder Rating Scale (ADHD-RS), respectively. Results: Significant, but modest, decreases in the severity of depressive symptoms (CDRS before vs after scores: 65.5 +/- 10.8 vs 58.3 +/- 8.2; paired t test, 3.1; df, 10; P =0.01) and ADHD symptoms (Attention Deficit/Hyperactivity Disorder Rating Scale before vs after: 36.4 +/- 5 vs 32.8 +/- 5; paired-t test, 2.94; df, 10; P = 0.015) were obtained after reboxetine treatment. The patients (n = 5) with high baseline scores of CDRS (T score > 75) showed a trend toward larger response to reboxetine than those (n = 6) with low (T score < 75) basal CDRS scores (Delta, 12.8 +/- 5.4 vs 2.3 +/- 5.2; P = 0.07). A significant positive correlation was found between the changes in the total scores of the depression and the ADHD severity (Spearman correlation r = 0.65 [95% confidence interval, 0.09-0.9]; n = 11; P = 0.029). Most of the patients (approximately 90%) reported tolerable adverse effects. Conclusions: Reboxetine treatment may reduce, modestly but significantly, depressive and ADHD symptoms in adolescents with ASD. High rate of adverse effects requires close monitoring.