Depression in autism spectrum disorder: a scoping review of pharmacologic, neuromodulation, and psychosocial interventions

Introduction Major depressive disorder is common in autism spectrum disorder, but diagnosis and treatment are complicated by symptom overlap, atypical presentations, alexithymia, and limited ASD-specific evidence. Methods We conducted a scoping review of PubMed, PsycINFO, and reference lists for studies published from 1995 through 2025 examining pharmacologic, neuromodulation, and psychosocial interventions for depressive symptoms in ASD. Results Psychosocial interventions, including autism-adapted cognitive behavioral therapy, mindfulness-based therapy, dialectical behavior therapy-informed approaches, behavioral activation, PEERS, exercise, and animal-assisted therapy, were associated with improvements in depressive symptoms in open-label studies and small randomized trials. Neuromodulation findings were preliminary, while evidence for electroconvulsive therapy and deep brain stimulation was primarily case-based. Pharmacologic recommendations were based largely on expert consensus and indirect evidence rather than ASD-specific controlled trials. Discussion Depression treatment in ASD remains understudied. Larger controlled trials using ASD-validated depression measures, broader representation across support needs, and assessment of functional and long-term outcomes are needed.