According to a recent study, people with autism spectrum disorders are more than three times as likely as the general population to struggle with depression. Nearly 20 percent of people with autism also had depression. What’s more, higher functioning people without intellectual disabilities were even more severely affected. Not only were they depressed at a higher rate than autistic people with intellectual impairments, but they were also four times more likely to be depressed than the general population. This may be because people with higher functioning forms of autism are more aware of their difficulties and it may be partly because depression is harder to diagnose in more severely impaired patients. The study, led by Dheeraj Rai of the University of Bristol, followed more than 200,000 Swedes for 10 years. Of this group, more than 4000 had been diagnosed with an autism spectrum disorder. The study tracked participants’ mental health and found that while about six percent of the general population struggled with depression, 19.8 percent of people diagnosed with autism spectrum disorders struggled with depression by their mid to late twenties. Although depression does have a genetic component, the study also found that the cause of depression in people with autism spectrum disorders wasn’t entirely genetic. The researchers found that people with autism had twice the risk of depression as siblings without autism.This suggests autism itself may lead to depression. The researchers note that people with autism often struggle with social isolation, bullying, and exclusion. People who are diagnosed with autism spectrum disorders later in life may experience chronic stress from knowing they are somehow different from others but not knowing exactly why. Lack of social connection is a significant risk factor for depression. A common misconception about autism is that people on the spectrum prefer to be alone. More commonly, people with autism, especially high-functioning autism, crave social connection and don’t quite understand why they don’t fit in. They may feel loneliness more frequently and more intensely than other people. Even worse, autism and depression may lead to substance use and addiction as a way of coping with isolation or fitting in. One Swedish study found that people with autism were more than twice as likely as the general population to become addicted to drugs and alcohol. As with depression, those most affected were those without intellectual impairment. Unfortunately, substance use typically makes depression worse. Autism also frequently causes intense anxiety, which can also contribute to depression. Autism is often characterized as a sensory integration disorder, meaning people with autism have trouble making sense of everything happening around them. They may have difficulting concentrating on one specific thing and they may feel overstimulated by their surroundings. Repetitive behaviors are thought to be a way of dealing with this overstimulation. People with autism may experience intense anxiety in social situations. When they don’t intuitively understand what’s going on, they may feel overwhelmed trying to process social cues and fret over misinterpretations. Despite the high risk of depression in people with autism spectrum disorders, diagnosing depression in this population is often much harder. People with autism typically have trouble identifying and expressing their emotions. Although depression symptoms are the same for people with autism, they are often masked by autistic symptoms. Symptoms of depression include persistent sadness, inability to feel pleasure, irritability, sleep disturbance, loss of interest in things you used to enjoy, aches, emotional numbness, and thoughts of death or suicide. Many of these symptoms may be difficult to distinguish, and the person suffering from them may not recognize them or know how to talk about them. For example irritability as social isolation are typical of both autism and depression. A diagnosis often depends on observation by a psychologist or reports from family members. Although depression may be difficult to spot among people with autism, there is now strong evidence that we should be looking for it. We know that it disproportionately affects autistic people with higher intelligence. We also know that there is a genetic component, so while autism alone can lead to depression, depression is more likely when a family member also suffers from depression. However, there are two caveats. First, depression often goes undiagnosed and, second, autism, especially high-functioning autism often goes undiagnosed. The good news is that awareness of both these conditions is spreading, which allows more people to get treatment. Depression in autistic people is typically treated with SSRI antidepressants. It’s not clear how effective these are. Although they effective for about half of neurotypical people with depression, autistic brains are wired differently. SSRIs have been used to treat the regular symptoms of autism, but there is little evidence this is effective. Given how little research has been done on this relatively new issue, depression in people with autism spectrum disorders may have to proceed case by case. Often, people with autism get worse side effects, such as disturbed sleep or irritability, from medication. The good news is that non-medication treatments may be effective for many people with autism spectrum disorders. One small study found that cognitive behavioral therapy, or CBT, the most commonly used form of psychotherapy reduced depression symptoms in people with high-functioning autism. Another study found that mindfulness training, which emphasizes acceptance of troubling emotions, was also helpful for people with high-functioning autism. These interventions aren’t mutually exclusive. Although they may not be effective for people with intellectual impairments, depression is most common among people with higher-functioning autism, so they may still do a lot of good. However, it’s problem that clearly needs more research.
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