Hi all! In the last post I started summarizing a series of studies that look at the scientific evidence for the effectiveness of specific treatments for symptoms of autism. I began by discussing research that suggests that Secretin is not an effective treatment for autism. This week I’m discussing 3 additional medications (or classes of medications): antipsychotics (such as Risperidone), SSRIs (such as Prozac), and psychostimulants (such as Ritalin).

The effectiveness of these medications was recently reviewed in an article published in the Journal Pediatrics. The authors examined all previous studies that used good research methods to investigate whether these medications were effective in the treatment of some symptoms of autism. In addition, the authors were interested in determining whether the medications were safe.

Here is a summary of their results:

ANTIPSYCHOTICS:

Risperidone (Risperdal): The authors found 2 good randomized clinical trials (RTC) that compared Risperidone to a placebo (e.g., sugar pill) and 2 prospective studies that examined changes in challenging and repetitive behaviors after starting the medication. One of the studies was funded by the National Institutes of Health and the other was funded by the makers of the drug. In both studies, kids taking Risperidone improved significantly more than kids taking the sugar pill. Similar improvements were seen for hyperactive symptoms and repetitive behaviors. The authors concluded that evidence for the effectiveness of Risperidone in reducing challenging and repetitive behaviors was moderate. However, the was also significant evidence for adverse side effects including weight gain (an average of approximately 6 lbs. in 8 weeks), sedation, and some neurological symptoms.

Aripiprazole (Abilify): The authors found 2 good quality RTCs comparing Aripiprazole to placebos for the treatment of challenging and repetitive behaviors. In both studies, kids taking Abilify improved significantly more than kids taking the sugar pill. The authors concluded that evidence for the effectiveness of Aripiprazole in reducing challenging and repetitive behaviors was High. However, the was also significant evidence for adverse effects including weight gain (an average of about 4 lbs. in 8 weeks), sedation, and some neurological symptoms.

SSRI (Selective Seretonin Reuptake Inhibitors):

Citalopram (Celexa): There was one good quality study comparing Citalopram to a placebo. There was no difference between kids taking Celexa and those taking the sugar pill in their levels of repetitive behaviors after 12 weeks of taking the medication. However, the levels of challenging behaviors decreased more among those taking Celexa than among those taking the placebo. Since there was only one study showing these trends and the results were modest, the authors concluded that at this time there was insufficient evidence for the effectiveness of this medication .

Fluoxetine (Prozac): There was one good quality RTC comparing Prozac to a placebo. Kids taking Prozac showed a larger decrease in repetitive behaviors than did kids taking the placebo. There were no major adverse side effects. It seems, therefore, that Prozac may be more effective than Celexa in treating repetitive behaviors.

PSYCHOSTIMULANTS:

Methylphenidate (Concerta, Ritalin): There was one good quality RTC comparing Methylphenidate to a placebo for the treatment of hyperactivity and non-compliance. Kids taking the medication improved significantly more than kids taking the placebo, but this was mostly at medium to high dosages (dosages ranged from 7.5 to 50 mg per day). However, some major side effects were reported including irritability (18% of those who quit the study did so because of irritability), sleep problems, anxiety, depression, and diarrhea.


What is most surprising about this comprehensive review is how little we actually know about the effectiveness and safety of these medications. We know most about Risperidone and Aripiprazole. Both of these medications appear to be effective although they have some severe side effects. The authors concluded that future research is unlikely to change these findings. However, we know significantly less about the effects of SSRIs and psychostimulants and we need much more research before we can determine conclusively whether these medications are effective and safe for the treatment of some symptoms of autism.

The reference:
McPheeters, M., Warren, Z., Sathe, N., Bruzek, J., Krishnaswami, S., Jerome, R., & Veenstra-VanderWeele, J. (2011). A Systematic Review of Medical Treatments for Children With Autism Spectrum Disorders PEDIATRICS, 127 (5) DOI: 10.1542/peds.2011-0427

Post to Twitter

4 Responses to Antipsychotic and other medications for autism: The state of the evidence

  1. DSC says:

    Humph. One likely cause of what we call ‘autism’ may be due to antibiotic overuse and a new influx of bacterial and yeast variants that put out chemicals that interfere with neurotransmitter fnction.

  2. Mehrzad Araghi says:

    Hi Nestor and Anita,

    as a special needs advocate and ADHD coach, I agree wholeheartedly that there is a huge need for research results to be reported to parents and other interested “non-experts” in a way that is understandable and potentially actionable, but does not oversimplify the information. I like what you’ve done here and wanted to share a client story in hopes that it would generate some more reports of this kind:

    In late 2009, one of my client families experienced such severe dysregulation with their first-grade son who is on the autism spectrum, that the risks of not treating him effectively outweighed the risks of Abilify. The medication did result in a significant improvement in his behavior, however he also gained a HUGE amount of weight, was increasingly lethargic, and seemed to be “slipping away” mentally and emotionally.

    In this unsustainable situation, they were lucky to find a local pediatric psychiatrist with knowledge of a broader range of therapies. With his help, they were able to transition their son from 10mg of Abilify to an intensive vitamin & mineral supplement…and he is doing MUCH better. For the first time he has been able to remain in his regular-education classroom — supported by a well-trained aide — all year. Once he was stabilized with the nutritional supplement, the psychiatrist was able to use a micro-dose of Risperdal to address his remaining mental disorganization without creating the usual side effects. The combination has been so effective that his end-of-year check-in, his second-grade teachers reported that he has been working doggedly to do his “best work,” even asking to re-do writing tasks (he struggles with writing) when he felt he could do better.

    I’m aware that my effusive report seems like a “too good to be true” promotional rant — I feel the same way but also felt it was important to capture the actual level of impact rather than dampen it for the sake of seeming more objective. Although I do believe that good nutrition is a significant support, I would never have predicted that a supplement would work better than 10mg of Abilify.

    I have specifically not mentioned the name of the product because this is a research-based site and if the research doesn’t support this supplement I don’t want to encourage anyone to base medication decisions on my one anecdote. What I am hoping, though, is that you can investigate the effectiveness of this product and perhaps some other nutritional/neutraceutical interventions like fish oil, in future posts.

    Thanks, and keep up this good work.

    Best regards,

    Mehrzad Araghi

  3. Tony says:

    Drug companies have billions to spend on research. The fact that so few good quality RTCs exist would suggest the drugs aren’t really that effective at all. Those studies that were reviewed could just be the typical publication bias we see when they do find something and the ones that find nothing or negative affects just don’t get to see the light of day.

    Anti-depressant anyoen?

  4. Ettina says:

    “There was no difference between kids taking Celexa and those taking the sugar pill in their levels of repetitive behaviors after 12 weeks of taking the medication. However, the levels of challenging behaviors decreased more among those taking Celexa than among those taking the placebo.”

    I wonder how often ‘challenging behavior’ in autism represents undiagnosed depression? Some studies show that autistic kids are at very high risk for abuse, and respond to traumatic experiences with increases in tantrums, self-injury and so forth. And many more verbal autistics have described the frustration of being misunderstood and discriminated against, which is probably even worse for the more severely affected individuals.

    Perhaps the success of anti-depressants is related to undiagnosed depression, rather than a direct effect on the autism itself.

Leave a Reply

Your email address will not be published. Required fields are marked *

*


four + = 10

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>

Looking for something?

Use the form below to search the site:


Still not finding what you're looking for? Drop a comment on a post or contact us so we can take care of it!

Set your Twitter account name in your settings to use the TwitterBar Section.