Psychoactive Medications and ASD

Considering Pharmacologic Intervention

Why would we consider using psychopharmacologic agents to treat problems in a person with Autism Spectrum Disorder (ASD)? – Treatment of core symptoms– Maladaptive behaviors sometimes seen in

ASD– Treatment of coexisting psychiatric problems

Do No Harm

• The Basic Rule of thumb when considering any treatment including medications for individuals with ASD is “first do no harm.”

• When medications have multiple potential side effects and relatively little evidence for use in the scientific literature, I have to be sure that not prescribing medication would be more harmful than prescribing medication.

• The same is true for any other intervention.

Core Symptoms of ASD

Problems with Social RelatednessProblems with LanguageProblems with fixations, repetitive

behaviors and rigidity.

Coexisting Psychiatric Problems

• ADHD• OCD• Tics/Tourette’s Disorder• Anxiety Disorders• Mood Disorders– Depressive Disorders– Bipolar Disorder

• Psychosis

Maladaptive Symptoms/Behaviors sometimes seen in ASD

There are behaviors that do not easily fit a particular psychiatric diagnosis that occur in ASD.

– Aggression– Severe tantrums and agitation– Self Injurious Behaviors– Sleep Disturbance– Rigidity– Perseveration

Pharmacologic Studies

Reference for the Above slides

Stimulants

• Methylphenidate –studies listed above– Ritalin – Metadate– Concerta– Daytrana– Focalin (DextroMethylphenidate)

• Amphetamine – no know studies– Adderall– Dexedrine (DextroAmphetamine)– Vyvanse (lisdexamfetamine dimesylate)

Alpha Adrenergic Medications

Tenex (Guanfacine) – Posey, D.J. et al., 2004 retrospective study of 80 cases

Catapress (Clonidine) – Frankhauser, MP et al., 1992 9 boys placebo double blind

• Other antihypertensive are also sometimes used mostly from the Beta Blocker class– Propranolol/Inderal – Ratey, John et al., 1987

open label 8 children– Pindolol

Noradrenergic Reuptake Inhibitors

Strattera/Atomoxetine – Arnold, LE et, al., 2006 16 children

Effexor/Venflaxamine (SSRI and NRI) – Hollander, E et al., 2000 retrospective study of adults with ASD

Cymbalta/Duloxetine (SSRI and NRI) – no research that I know of

Antidepressants

Serotonin MedicationsProzac – see aboveZoloft – none knownLuvox –see aboveCelexa – on going

studiesLexapro – study

completed not published

Paxil – no known study

Wellbutrin – no known studies

Trazadone – no known studies

• Tricyclic Antidepressants– Clomipramine – see

studies above– Disimpramine – see

studies above– Imipramine –

Campbell, et al., 1971 10 children single blind

– Nortriptyline – no known studies

– Amitrityline – no known studies

• Remeron – no know studies

Antipsychotics/Neuroleptics

• Risperdal -FDA approved for use in people with ASD studies above

• Abilify –FDA approved for use in people with ASD • Zyprexa – Kemner, C et al., 2002 25 children open label

with some improvement• Seroquel – Hardan, A. Y. et al., 2005 retrospective study

in children with PDD• Geodon –Malone, R et al., 2007 open label 12

adolescents• Mellaril – I know there are early studies but generally

not used given side effects• Clozaril – a few studies none particularly conclusive

AntiConvulsants

Depakote – Hollander, E et al., 2006 13 double blind study

Lamictal – Belsito, K.M. et al., 2004 28 children placebo double blind

Tegretol- no known studiesTrileptal – studies on goingTopamax – Canitano, R 2005 open label for

weight gain from nueroleptics

Anticholinesterase Inhibitors and

NMDA antagonists

Aricept (donepezil)- Chez, M et al., 2003 43 children double blind placebo

Namenda (memantine) – Owley, T et al., 2006 14 children open label study

Symmetrel (amantadine) – King, BH et al., 2001 39 children double blind clinicians saw improvement but parents did not

Razadyne (galantamine) – R. Nicholson, MD et al., 2006 13 children open label trial

Other Pharmacologic Interventions for ASD Core

Symptoms with some Promising Evidence

Oxytocin – Hollander et al., 2003 15 adults with autism

Vancomycin- Sandler et al., 2000 10 children open study blinded video evaluation 8 children improved

Minocycline- being studied National Institute of Health Clinical Centers funded by the NIMH

D-Cyclosporine –Posey et al., 2004 2 week single blind placebo treatment with 10 subjects NMDA agonist

Vitamin C- Dolske et al., 1993 decreasing stereotyped behaviors in a 30 week double blind study with 18 children

Cyanocobalamine (B-12) - James et al., 2004Cypropheptadine- S. Akhondzadeh, PhD et al., 2004 Rapamycin

Continued

Arbaclofen – a GABA agonistN-Acetylcysteine – antioxidant/decreased

glutamate nuerotransmissionPropranolol – help with fluency in language

Conclusion

The take home message is that medications can be helpful with the impairing symptoms of PDD, but medications are not specific and there can be significant side effects associated with their use.