Medicines for autism

Medicines have a limited role in improving symptoms of autism. However, some may help prevent self-injury and other behaviors that are causing difficulty. Medicines may also take a child to a functional level at which they can benefit from other treatments.

There is no standard medicine for the treatment of autism. The American Academy of Pediatrics (AAP) suggests targeting the main one or two problem behaviors when considering medicines.¹

Medicines that are sometimes used to treat behaviors related to autism include selective serotonin reuptake inhibitors and antipsychotic medicines.¹

Selective serotonin reuptake inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) include citalopram (Celexa), fluoxetine (Prozac), and sertraline (Zoloft, Lustral). The high rate of effectiveness for depression, anxiety, and obsessive, stereotypical behaviors has made these medicines a popular choice for managing autism. They may also improve general behavior, language, learning, and socialization. In addition, although SSRIs have side effects, such as weight gain, insomnia, and increased agitation, they tend to be less serious than those of antipsychotic medicines.

FDA advisory. The U.S. Food and Drug Administration (FDA) has issued an advisory to patients, families, and health professionals to closely monitor adults and children taking antidepressants for warning signs of suicide. This is especially important at the beginning of treatment or when doses are changed.

The FDA also advises that patients be observed for increases in anxiety, panic attacks, agitation, irritability, insomnia, impulsivity, hostility, and mania. It is most important to watch for these behaviors in children who may be less able to control their impulsivity as much as adults and therefore may be at greater risk for suicide. The FDA has not recommended that people stop using antidepressants but simply to monitor those taking the medicines and, if concerns arise, to contact a health professional.

Antipsychotic medicines

Antipsychotic medicines, such as haloperidol (Haldol), risperidone (Risperdal), and thioridazine work by changing the effects of brain chemicals. They may help decrease problem behaviors that can occur with autism. A well-designed study found that risperidone was effective for the treatment of tantrums, aggression, and self-harming behavior in children with autism.^{2, 3}

However, these medicines can have side effects, including sleepiness, tremors, and weight gain. Their use is usually considered only after behavior management has failed to address the problem behaviors.

Other medicines that are sometimes used include:¹

• Clonidine (Catapres) and guanfacine hydrochloride (Tenex). These medicines are typically used to lower blood pressure but are also used to treat impulsive and aggressive behaviors in children with autism.
• Lithium (Eskalith, Eskalith-CR, Lithobid, Lithonate, Lithotabs) and anticonvulsants, such as carbamazepine (Carbatrol, Epitol, Tegretol) and valproic acid (Depakene). Children who are occasionally aggressive may become more stable when using these medicines, although monitoring the level of the drug in the body through regularly scheduled blood tests is required.

The effectiveness of these medicines varies by individual. Side effects are possible and should be discussed with your health professional. Some health professionals may advise going off a medicine temporarily, in order to identify whether it is having a positive or negative effect.

Citations

1. Committee on Children with Disabilities, American Academy of Pediatrics (2001). Technical report: The pediatrician's role in the diagnosis and management of autistic spectrum disorder in children. Pediatrics, 107(5): 1–18.

2. McCracken JT, et al. (2002). Risperidone in children with autism and serious behavioral problems. New England Journal of Medicine, 347(5): 314–321.

3. U.S. Food and Drug Administration (2006). FDA approves the first drug to treat irritability associated with autism, risperdal. FDA News. Available online: http://www.fda.gov/bbs/topics/NEWS/2006/NEW01485.html.