DEPRESSION & AUTISM SPECTRUM DISORDERS

Adults on the autism spectrum can be prone to depression and other mental health problems such as anxiety and obsessive-compulsive disorders, especially in late adolescence and their twenties. But these adults often have trouble communicating these feelings of disturbance, anxiety or distress and it is common for these to go undiagnosed until the effects are very evident.
It is important that any health professional involved is familiar with Asperger's syndrome and other Autism Spectrum Disorders, and is familiar with the person's style of communication. This is where partners or family members can help by providing the health professional with examples of how the person's behavior and emotional state have changed.

Why is depression common with autism and Asperger's syndrome?

An adult on the autism spectrum may face a range of difficulties across three broad areas, sometimes called the triad of impairments. This means that problems will be experienced to varying degrees with social communication, social understanding and imagination. The person can have trouble in appropriate social interaction with others, establishing and maintaining friendships and being able to anticipate what will happen in given situations. Depression is an understandable reaction to employment difficulties, social isolation, relationship issues and problems with adapting to a non-autistic world.

Signs and Symptoms

The common signs and symptoms of depression include changes in:
• Mood e.g. extreme sadness, despair, flat emotional reactions and irritability
• Changes in thinking patterns e.g. a sense of hopelessness, pessimistic beliefs
• Behavioral changes e.g. reduced attention to physical appearance, withdrawal
• Physical symptoms e.g. sleep disturbance, appetite changes, tiredness.

People’s experience of depression usually occurs on a continuum ranging from very mild to very severe. The most important consideration is therefore the severity of the person’s depression and how long it lasts. Many people are able to self-manage their depression using strategies. Other people require psychological support or other forms of treatment from professionals.

Personal Strategies for Coping with Depression

The following strategies have been suggested by people with acquired brain injury and may be useful.
• Having a nap
• Listening to music
• Watching television
• Working on a personal project
• Socializing
• Walking or other exercise
• Mental stimulation
• Scheduling activities and making short-term plans
• Self-Talk or thought challenging.]

Self-Talk

Self-Talk is a useful technique for modifying inaccurate and upsetting thoughts. It requires the practiced art of replacing upsetting thoughts with constructive explanations. For example instead of thinking, “I'm useless and I never get anything right,” the person can replace their thoughts with a constructive explanation such as, “I need to learn more about reading other people's body language, I'll do better next time.”

Treatment Approaches for Depression

Psychological therapy

This form of treatment is usually most effective with mild or moderate to severe forms of depression. In general, people with very severe forms of depression will require other interventions e.g. hospitalization or medication. After a person’s state of mind has improved they may be more likely to benefit from psychological support to further reduce symptoms and provide ongoing management.

Antidepressant medication

Medication is often used in association with psychological therapy for the person with depression who does not respond well to psychological therapy. Medication may help to relieve depression by adjusting the chemical levels in the brain. Depression is often caused by an excess or a deficiency of particular chemicals in the brain. Such chemicals are created naturally within our bodies and affect our moods, thinking, behavior, sleep, energy levels, appetite, concentration and other daily functions. In cases of depression, a doctor may suggest medication to address any chemical deficiency that may exist.

The choice of medication depends upon a range of considerations such as:
• Side effects
• The person’s previous response to medication
• Interaction with other medication being taken
• Safety in overdose.

Most antidepressants take about two weeks before a person will notice any change in mental and physical state. Medication needs to be trialed for at least four to six weeks and should generally be taken for approximately six to twelve months even if the person feels better after a few months. People are advised to see a general practitioner or psychiatrist to discuss issues relating to medication.

SUICIDE

Given the many difficulties faced by adults on the autism spectrum, feeling suicidal can occur when problems mount up. It is crucial to look for support or see a doctor during this periods as appropriate support will normally allow the person to get through these deep depressive episodes.

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