Psychoactive Medications and ASD
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Transcript of Psychoactive Medications and ASD
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
AntidepressantsSerotonin Medications
Prozac – 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.