Psychoactive Medications and ASD

1. Psychoactive Medications and ASD

2. 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

3. 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.

4. Core Symptoms of ASD Problems with Social Relatedness Problems with Language Problems with fixations, repetitive behaviors and rigidity.

5. Coexisting Psychiatric Problems • ADHD • OCD • Tics/Tourette’s Disorder • Anxiety Disorders • Mood Disorders • Depressive Disorders • Bipolar Disorder • Psychosis

6. 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

7. Pharmacologic Studies

11. Reference for the Above slides

12. Stimulants • Methylphenidate –studies listed above • Ritalin • Metadate • Concerta • Daytrana • Focalin (DextroMethylphenidate) • Amphetamine – no know studies • Adderall • Dexedrine (DextroAmphetamine) • Vyvanse (lisdexamfetaminedimesylate)

13. 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

14. 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

15. Serotonin Medications Prozac – see above Zoloft – none known Luvox –see above Celexa – on going studies Lexapro – 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 Antidepressants

16. 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

17. 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 studies Trileptal – studies on going Topamax – Canitano, R 2005 open label for weight gain from nueroleptics

18. Anticholinesterase Inhibitors andNMDA 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

19. 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., 2004 Cypropheptadine- S. Akhondzadeh, PhD et al., 2004 Rapamycin

20. Continued Arbaclofen – a GABA agonist N-Acetylcysteine – antioxidant/decreased glutamate nuerotransmission Propranolol – help with fluency in language

21. 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.