The Link Between Autism & Depression

Depression is one of the most common mental health disorders. Over 264 million people struggle with depression worldwide¹. This type of mental health disorder is also highly comorbid, meaning it often occurs alongside another disorder.

A disorder that is often comorbid with depression is autism. Diagnosing depression with autism can be difficult and complex. Treatment can address symptoms of both disorders and understanding the signs or symptoms can help with diagnosis.

What is Autism?

Autism is often called Autism Spectrum Disorder (ASD) because it encompasses three different levels of autism. The different levels of ASD represent the severity and amount of support needed. Level 1 requires support, level 2 requires substantial support, and level 3 of ASD requires very substantial support.

Autism Spectrum Disorder is defined by the Diagnostics and Statistics Manual of Mental Health (DSM-5) with these characteristics in common:

• Impaired communication skills
• Dysfunctional social interactions
• Strict, repetitive patterns of behavior

An estimated 1 in 44 children receives an autism diagnosis every year in the US³. The rate of diagnosis for boys is four times higher than for girls. Autism has mostly equal rates within all economic and racial groups.

The signs of autism can manifest in social interactions, behavior, and communication skills. But symptoms can widely vary and even change throughout the lifespan.

Babies as young as a few months can show signs of autism, including¹¹:

• Decreased eye contact
• Limited pointing and gesturing
• Not following when someone else points (joint attention)
• Little response to their name
• Lack of emotional expression
• Delayed or uneven speech progression

But sometimes, babies with ASD don’t show any of these signs. Development might follow typical patterns until reaching pre-school age. Studies show that over one-third of children with ASD display regression in development by toddlerhood².

Autism in children, teens, and adults is associated with struggles in social situations. Difficulties building relationships and bonding with others is common with ASD. Preferring to spend time alone, not relating to peers, and getting upset when others do not follow the rules are often signs of autism.

Communication Difficulties

Autism can also make both verbal and non-verbal communication hard. Interactions with others and social communication can be difficult tasks. Without understanding social cues and rules, communication can be challenging with ASD.

Communication symptoms include:

• Having difficulty discussing a range of topics
• Talking consistently about their interests only
• Using an unsual tone of voice or speaking at an inappropriate volume
• Struggling to understand sarcasm, idioms, or humor
• Finding it confusing to follow multi-step instructions
• Using eye contact, volume, and gestures inappropriately
• Struggling to show emotions or read facial expressions

Behavior Challenges

Autism can also affect behaviors and often mimicks obsessive-compulsive disorder symptoms. Restrictive and repetitive behaviors set autism apart from other disorders related to communication.

Behaviors related to autism include:

• Having hyper fixation on specific interests and hobbies
• Repeating movements, gestures, or facial expressions
• Forming strong attachments to objects
• Becoming upset by insignificant changes or breaks in routine
• Showing compulsive behaviors
• Struggling with sensory issues
• Seeking sensory stimulation

Autism is a lifelong condition that doesn’t disappear with age or treatment. But some studies have found that symptoms can become less severe with time and treatment⁸.

There is no single cause for autism. Researchers believe it may be due to a combination of environmental and genetic influences.

Some proposed risk factors can be:

• Genetic disorders or mutations
• Low birth weight
• Exposure to toxins
• Family history of autism
• Metabolic imbalances

Most researchers don’t seek to cure ASD but rather reduce its severity. Therapy, meditation, and lifestyle changes might help with the management of autistic symptoms.

What is Depression?

Depression is a common mood disorder that affects over 17 million American adults⁵. But adults are not the only ones who struggle with depression. Almost two million children have a major depressive disorder diagnosis.

Mild to moderate depression can affect every sphere of life, including school, work, and relationships. Severe depression can even lead to self-harm and suicide. Thankfully, depression is treatable with a combination of medication and therapy.

The signs of depression can differ between individuals and across age groups. Symptoms of depression must be severe enough to disrupt their life. Most depression diagnoses require signs to be present for two weeks or longer. A doctor should rule out other medical reasons before confirming a diagnosis of depression.

Common symptoms of depression include:

• Feelings of intense sadness
• Changes in appetite and sleep
• Constant fatigue and lack of energy
• Loss of interest in hobbies
• Withdrawal from social activities
• Feelings of worthlessness, guilt, or shame
• Intrusive thoughts
• Difficulty focusing
• Brain fog and confusion
• Inability to make decisions
• Changes in behavior
• Thoughts of suicide

Researchers are still studying the causes of depression. Traumatic events, genetics, chronic illness, and certain medications are thought to have the potential to trigger depression.

There’s also a connection between neurotransmitters and depression. Medication aimed at treating it often attempts to balance levels of certain hormones. Depression can be treatable with medication, therapy, or alternatives like TMS therapy.

The Depression & Autism Connection

Studies show that people with ASD are four times more likely to experience depression than others⁹. The autism and depression link tends to develop in adolescence.

• Autistic teens might develop depression due to feelings of:
• Isolation
• Differing from peers
• Pressuring from academics and social situations
• Failing to understand social rules and make strong friendships

Adolescence can be when social groups become a strong influence in a teen’s life. The unwritten rules of high school, teen friendships, and identity exploration can be tough to understand. These rules can be intensely more difficult for teens with autism to navigate.

Studies also found that high functioning autism and depression are more closely related⁶. Higher IQ proved to be a risk factor for depression in these studies. This finding might be due to higher self-awareness and understanding of “being different.”

What Depression Looks like for People with Autism

Depression is often a difficult diagnosis when already diagnosed with autism. The challenge is that symptoms of the two disorders overlap one another. Lack of emotion, a flat affect, and social withdrawal are signs of ASD and depression.

Furthermore, communication is a common struggle with autism. Voicing depression symptoms or recognizing the signs of depression clearly may be difficult. A depression diagnosis relies heavily on self-reports making this even more difficult for people with ASD.

Autistic with depression symptoms can include:

• Compulsive behavior that are increasing in frequency and severity
• Increasing aggression, frustration, and tantrums
• Self-harming behaviors like hair pulling, biting, etc.
• Sleeping disturbances
• Talking about death, suicide, or self-harm
• Increasing isolation and withdrawal from social activities
• Struggling to do basic things like personal care, homework, etc.

Autistic symptoms might become more extreme when teens are struggling with depression. Teens with autism and depression might have a harder time with communication and social skills, creating a vicious cycle of isolation.

Depression & Autism Help

Treating depression in people with autism can be challenging. Traditional treatments like psychotherapy may cause more anxiety and stress.

The first line of treatment for depression is usually selective serotonin reuptake inhibitors (SSRIs). SSRIs work by blocking the absorption of serotonin to increase its levels in the brain. This process can lead to the smoother transmission of signals between nerve cells.

But clinicians have found that SSRIs aren’t very effective for ASD. Currently, only two FDA-approved medications are beneficial in treating some symptoms of depression in autistic patients⁴. Risperidone and Aripiprazole can reduce levels of irritability for people with ASD.

Cognitive-behavioral therapy (CBT) is a standard treatment for depression. The goal of CBT is to change negative thoughts, unproductive coping mechanisms, and cognitive inflexibility. CBT is often successful in creating a relationship between thoughts, reactions, and behavior.

The challenge with CBT is that it’s structured for individuals without developmental difficulties. Thus, when an autism diagnosis is present, often specialized versions of CBT are needed. Clinicians often adapt the CBT framework for autism by focusing on anxiety, anger, emotion regulation, insomnia, and obsessive-compulsive disorder symptoms.

There are few studies on the efficacy of this adapted version of CBT, but small cases show promise. One such small study with autistic teens showed that depressive symptoms improved¹². At the same time, CBT did not affect their anxiety levels.

The benefits of medication and psychotherapy have limitations for autism. Transcranial Magnetic Stimulation (TMS) can be a practical approach to treating autism with depression because there is little to no communication involved.

TMS is non-invasive, free from medication, and associated with little to no side effects. Treatment involves the placement of a coil on the scalp to deliver electromagnetic pulses to regions of the brain responsible for mood control. The procedure lasts about 30 to 50 minutes in a comfortable, private room. There’s no recovery time, and patients can go about their daily lives without worry.

In one small study, 70% of participants with autism showed positive reactions to TMS. They reported decreased symptoms of depression, irritability, and hyperactivity⁷. TMS might soon prove to be at the forefront of depression treatment for patients with ASD.

Lifestyle changes can be beneficial when developmental disorders and depression are co-occurring. The focus is usually on nutritious eating, exercising, and self-care activities. Mindfulness activities like journaling and meditation can help with symptom alleviation as well.

To benefit mental health, lifestyle changes for ASD can be helpful. A healthy, structured daily routine can provide relief for symptoms. Spending time pursuing hobbies and socializing with family can relieve loneliness.

A healthy amount of exercise may decrease depression in teens with ASD. One study had participants attend 90-minute workout classes twice a week and increase their daily movement. After six weeks, most participants showed a decrease from mild depression to minimal levels¹⁰.

Find Mental Health Help Today

Although depression affects many, people with ASD are more likely to experience it. People with autism tend to have a unique experience with depression that tends to be difficult to diagnose. Treatment for autism and depression can include therapy, medication, or transcranial magnetic stimulation (TMS).

If you or a loved one are struggling with autism and depression, reach out to Brain Therapy TMS today. Our team can answer any questions you may have and give you a better understanding of our program.