SYSTEMATIC REVIEW article
Front. Psychiatry
Sec. Autism
Depression in autism spectrum disorder: A scoping review of pharmacologic, neuromodulation, and psychosocial interventions
- BG
Bharathi Gadad 1
- UG
Usman Ghumman 2
- CS
Celine Shafee 2
- NA
Nikhilesh Anand 1
- LA
Lina Altarawneh 3
- MI
Maria Iorini 4
- HK
hagar Kandel 5
- AL
Alissa Lopez 1
- JM
Jacqueline Mendoza 1
- AD
Anthony Dang 1
- AS
Aisha Saeed 5
- LM
Leonardo Magisano-Lamraoui 6
- TC
TOLGA CERANOGLU 2
- RB
Ricardo Belmares 1
- GJ
Gagan Joshi 1
1. The University of Texas Rio Grande Valley, Edinburg, United States
2. Harvard Medical School, Boston, United States
3. Northeastern University, Boston, United States
4. Weill Cornell Medicine - Qatar, Doha, Qatar
5. Riphah International University, Islamabad, Pakistan
6. Lexington High School, Lexington, United States
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Abstract
Autism spectrum disorder (ASD) affects almost 1 in 31 children and confers a high psychiatric comorbidity burden, including major depressive disorder (MDD) (lifetime prevalence 14-37%), exceeding general rates. Diagnostic challenges include diagnostic overshadowing, symptom overlap (e.g., social withdrawal, fatigue), atypical presentations (irritability, rigidity), alexithymia, and non-ASD-validated scales, leading to underdiagnosis or misdiagnosis. This scoping review synthesizes evidence from PubMed and PsycINFO and reference list searches (1995–2025) on pharmacologic, neuromodulation, and psychosocial interventions for depressive symptoms in ASD. Psychosocial interventions including autism-adapted CBT, Mindfulness-Based Therapy, DBT-informed approaches, behavioral activation, PEERS, exercise, and animal-assisted therapy were associated with improvements in depressive symptoms across open-label studies and small randomized trials, particularly when interventions incorporated visual and structural adaptations. Open-label neuromodulation studies reported preliminary reductions in depressive symptoms, while evidence for ECT and DBS was largely case-based. Recent expert consensus has suggested that duloxetine and selected atypical antidepressants (mirtazapine, bupropion, and vortioxetine) may be considered in selected individuals with ASD when concerns regarding SSRI tolerability arise. However, these recommendations are based primarily on expert consensus and limited indirect evidence rather than ASD-specific controlled trials.
Summary
Keywords
Autism Spectrum Disorder, cognitive behavioral therapy, Major Depressive Disorder, Neuromodulation, Pharmacotherapy, Transcranial Magnetic Stimulation
Received
11 June 2026
Accepted
31 August 2026
Copyright
© 2026 Gadad, Ghumman, Shafee, Anand, Altarawneh, Iorini, Kandel, Lopez, Mendoza, Dang, Saeed, Magisano-Lamraoui, CERANOGLU, Belmares and Joshi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Bharathi Gadad
Disclaimer
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