Transcript savannah medications - The Matthew Reardon Center for Autism

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 Relatedness
Problems with Language
Problems 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 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
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 studies
Trileptal – studies on going
Topamax – 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., 2004
Cypropheptadine- S. Akhondzadeh, PhD et al., 2004
Rapamycin
Continued
Arbaclofen – a GABA agonist
N-Acetylcysteine – antioxidant/decreased
glutamate nuerotransmission
Propranolol – 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.