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n June, Nicholas Lyons graduated from a private special-education high school in Maryland. Like many of his classmates, he is unsure what he is going to do next. His mother, Kelly Lyons, is worried, too — but more about his health than his plans: At 18, Nicholas has already endured several bouts of depression, one of which drove him to contemplate suicide.Nicholas was diagnosed with autism at age 9. By 12, the socially awkward, bright boy was in therapy for depression, too. “He was made fun of because he was different. He was smart enough to know that,” his mother says. “It posed a real problem.”
At 13, Nicholas’ mood plummeted further. He disengaged from everyday activities, such as talking with his family at dinner and playing video games, and he began sleeping a lot — common signs of depression. His mother increased his therapy sessions from once to twice a week. Meanwhile, his social problems only grew worse. “The autism caused me to take insults a lot. The insults were harsh,” Nicholas says. “Sometimes the kids made me angry. Sometimes it really annoyed me. The insults made me sad sometimes.”
The bullying got so bad that his mother pulled him out of the public school he was attending. He switched to a private special-education school, where he thrived until about age 17. Then he started worrying about what he would do after graduation. Again, he spiraled into depression, and his psychiatrist prescribed an antidepressant. The drug has helped Nicholas feel “even-keeled,” he says, but he is still anxious that his life is changing.
Nicholas’ ongoing battle with major depression is not unusual for people on the spectrum, according to a meta-analysis of 66 studies published in January: They are four times more likely than neurotypicals to experience depression over the course of their lives, although scientists are unsure why. Their rates of depression rise with intelligence and with age. In fact, says Carla A. Mazefsky, associate professor of psychiatry and psychology at the University of Pittsburgh in Pennsylvania, more than 70 percent of autistic youth have mental health conditions, including depression and anxiety, and these are thought to often persist or worsen into adulthood.
The consequences for many autistic people are dire. Major depression can severely impair their independence; their coping, daily living and social skills; and their communication — all things they may already find challenging. Depression can also trigger suicidal thoughts: Before Nicholas’ mother pulled him out of his public school, he had intended to end his life, she says.
Despite this grave set of circumstances, there is little hope available. There are no studies on which screening measures are most useful or which treatments work best to ease depression among autistic people. It is not known, for example, whether depressed autistic people respond differently to psychotherapy than others do, or how best to adapt treatments such as cognitive behavioral therapy for them. Talk therapy, in particular, may not work well for autistic people, because they can struggle with social communication and with identifying their feelings, a trait known as alexithymia.
It is also unclear what effect medications for depression have on people on the spectrum. “They may have more side effects and more difficulty,” says Jeremy Veenstra-VanderWeele, a child and adolescent psychiatrist at Columbia University in New York. Antidepressants can even disrupt autistic children’s sleep and make them more impulsive, potentially outweighing any benefits, he points out.
In addition to developing better screening tools and treatments for depression in autistic people, researchers are trying to get at the root causes involved. The origins of the overlap have not been easy to trace. “Despite us knowing that depression among people on the spectrum is a common problem, in truth we know alarmingly little about depression and autism,” Veenstra-VanderWeele says. “The whole field is moving very slowly.”