autism and clinical depression

[Marsha-Golden]

    
      Re: autism and clinical depression
    


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Posted by ccfNeuro MD on July 22, 1997 at 19:23:01:

In Reply to: autism and clinical depression posted by Marsha Golden on July 09, 1997 at 15:45:09:

: My grandson has received a preliminary diagnosis of atypical autism or PDD/NOS.  My daughter (adopted) is clically depressed (treated with Prozac) and has a biological family history of manic depression (her paternal aunt).  I read that there may be a genetic link between autism and affective disorders.  Does anyone know anything about this?  Does this have to do with serotonin in both diseases?  Can her daughter transmit this even though she is not autistic?
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Hello Marsha.    Autistic disorder (classic autism) refers to a specific neurologic disorder in which there is severe behavioral abnormalities in 3 areas:  (1) social interaction (2) language, communication, and play and (3) deficits manifested as stereotypies in which the child repetitively perform same action such as hand flapping, running in circles,  or flipping light switches.   Autistic individuals have impaired sociability and  impaired use of speech and gestures.  Children with autism do not know how to play; they do not engage in pretend play and do not seem to be aware of what the toys represent.
“Pervasive Developmental Disorder not otherwise specified”(PDD/NOS)  is a disorder pf children with autistic behavior who do fulfill the strict criterias for autistic disorder or other similar but distinct disorders such as “Asperger’s Sydrome” or “Disintegrative disorder”.  
Autism is associated by many different disease processes such as prenatal infections, metabolic disorders, and chromosomal abnormalities such as “fragile X syndrome”, “Angelman’s syndrome” or Cornelia de Lange’s syndrome.   There is a genetic component in some cases as well: in cases of autism in which there is no associated neurologic condition or identified cause, there is a 3-8 % risk of recurrence in families with one affected child.  (NEJM 1997; 337:97-104).
You are absolutely correct that there is an association between in affective disorders (which includes depression, bipolar disorder) and autism.   A study published in 1995 in the American Journal of Medical Genetics reported that there is an increased frequency of both social phobia and depression in families with an autistic child:  social phobia was 10x more common than in families of children with other disorders and major depression was over 3x as common. In 1994,  DeLong and Nohria speculated that a subgroup of autistic spectrum disorders may actually represent the early-life onset of a severe form of affective disorder, particularly bipolar disease (Dev Med Child Neur 1994; 36: 441-8)
Research into the pathophysiology of autism has focused, at one time or other, on several different neurotransmitters.  Recently, because of the noted association between affective disorders and autism, the neurotransmitter serotonin is being examined.  There are many reported abnormalities of serotonin in people with autistic disorders  but there is no unifying explanation (NEJM 1997; 337:97-104).  
I would suggest that you see a genetic counselor for more detailed information on chances of passing on autistic disorder in your family.  If you live in the Cleveland area, you may want to see a genetic counselor at the Cleveland Clinic (216- 445-5686)  Dr. Carolyn Green, a pediatric neurologist at the Cleveland Clinic, specializes in neurologic behavioral disorders. If you are interested in seeing her, you may call 216-444-5559 for an appointment.  Below I have listed the addresses of some organizations that may provide more information that’s helpful to you.  
This information is provided for general medical education purposes only.  Please consult your physician for diagnostic and treatment options of your specific medical condition.
Autism Research Institute  4182 Adams Ave., San Diego, CA 92116  Contact person: Barnard Rimland, Phd  Phone: [phone] Website: http://www.autism.org/ari
Autism Society of America  7910 Woodmont Ave. - Suite 650  Bethesda, MD 20814-3015  Phone: (800) 3AUTISM  Website: http://www.autism-society.org