Some people consider medications before any other treatment, while others use them only as a last resort. Whichever approach you take, medications are available to help with attention span, panic attacks, hyperactivity, self-injurious behaviours, aggression, obsessive-compulsive disorders, sleeping disorders, and seizures. When necessary medication should be used as part of an overall treatment plan that includes social, nutritional, educational and psychological treatment.
One of the primary classes of medications prescribed for autism is the anti-psychotic. These medications help to control the typical aggressive behaviours seen in many children with autism. While these medications are used to treat psychotic behaviours in psychiatric patients, they have also been shown to be effective with individuals with autism. But their use is not intended to imply that autism and psychosis are in any way related. These medications cannot “cure”, but they can eliminate or reduce many symptoms.
A number of anti-psychotic medications are available. Your child’s doctor will determine which medication is best and your job will be to report any and all side effects that could arise from use of the medication.
The medications in the category of anti-psychotic include:
Risperdal (Risperidone) is probably the most common anti-psychotic in use. It can help to lessen aggression, agitation and explosive or compulsive behaviours. It has been well studied for use with Autism/PDD patients, and appears to be effective. As with any medication, there can be side effects, but these are often minimal and include a sedative effect, weight gain, dizziness and muscular stiffness.
This is the category of medication used most often for individuals diagnosed with ADHD. Your physician may order these medications for your child if they have a comorbid attention disorder along with their diagnosis of autism. Stimulants affect how the brain controls impulses and regulates behaviour and attention. They do this by influencing the availability of certain chemicals, called neurotransmitters, in the brain.
The medications in the category of stimulants include:
- AMPHETAMINES (Dexedrine, Adderall)
- METHYLPHENIDATES (Ritalin, Concerta, Biphentin)
Antidepressants are used to treat moderate to severe depression. Although antidepressant medications will not cure depression, they can help achieve remission – the disappearance or nearly complete reduction of symptoms. Symptoms of depression may include: sadness, anxiety, depression-related sleep and appetite problems, concentration, and energy levels all can improve with antidepressant medications.
Precisely how antidepressants work to treat depression remains speculative. Scientists do know that antidepressants can influence brain activity through the effects they have on mood-related brain chemicals called neurotransmitters and certain nerve cell receptors. Nerve cells release neurotransmitters to communicate with other nerve cells in the brain. Neurotransmitters transmit signals across a gap (synapse) between the nerve cells.
Neurotransmitters associated with depression are serotonin, norepinephrine and possibly dopamine. Research suggests that people with depression have lower levels of one or more of these neurotransmitters.
The medications in the category of antidepressant in the serotonin re-uptake inhibitors (SSRIs) category include:
- ZOLOFT (Sertraline)
- PROZAC (Fluoxetine)
- CELEXA (Citalopram)
- LUVOX (fluvoxamine)
- PAXIL (Paroxetine)
There are dozens of antidepressants available, each affecting neurotransmitters in a different way. We have chosen to list just one category of them. You and your Doctor will work together to find the right medication for you.
Obsessive-Compulsive Disorder Medications
There are two groups of medications that are effective in the treatment of obsessive-compulsive disorder. They are tricyclic antiobsessional antidepressant (ANAFRANIL) and serotonin reuptake inhibitors (SSRIs) like PROZAC, LUVOX, ZOLOFT, PAXIL, and CELEXA.
Anti-Anxiety Medications (Anxiolytics)
Anxiolytics are drugs whose primary purpose is to relieve anxiety arising in normal life or in non-psychotic psychiatric disorders The term “minor tranquilizer” is sometimes used to describe the medications in this category. However, the word “minor” does not mean “mild.” It actually means that physicians prescribe these medications to reduce less severe symptoms of psychological dysfunction.
The medications often prescribed for panic attacks include:
- VALlUM (diazepam) – often used for panic attacks
- ATIVAN (lorazepam) – often used for panic attacks
Sedative-hypnotics (sometimes called depressants) sedate, calm, or relax most individuals at low doses and, at somewhat higher doses, induce sleep. The hypnotic effect of the medication-induced sleep is very different from the phenomena associated with hypnosis. The confusion is because we once believed that hypnosis induced a sleep-like trance. However, we now know that hypnotized people are very much awake. Many medications in this class, such as MEBARAL, are effective in reducing seizure activity and may be termed anticonvulsants. Physicians can also use these medications as muscle relaxants, although muscle relaxation is secondary to their effects on the Central Nervous System.
The medications in the category of sedative-hypnotics include:
- BARBITURATES (secobarbital, phenobarbital, and pentobarbital)
- BENADRYL(diphenhydramine) and PHENERG (promethazine)
Another class of medications which appear to help control the aggressive behaviours is the anti-epileptic. It appears that these medications help to stabilize brain activity and therefore assist in the control of behaviours. Each of these medications requires regular blood testing in order to ensure that liver or bone marrow damage does not occur. Since these medications are designed to treat seizure activity, they are often prescribed for individuals with autism who suffer a seizure disorder as well, and their use provides the additional benefit of behavioural effects as well.
DEPAKOTE (Valproate) is the most common anti-epileptic used by physicians. It has the benefits of lessening explosive behaviours and aggression. Additionally, since many children with autism suffer from seizure disorders it is considered to be one of the primary treatments for this condition as well. Most of the side effects, such as a sedative effect and an upset stomach, do not pose severe problems. One side effect, however, must be very carefully monitored with blood tests. Research has shown that on rare occasions Depakote can cause liver damage. For this reason, close attention must be paid to the Depakote levels in the bloodstream and their effect on the liver.
Another anti-epileptic having the same benefit as Depakote is TEGRETOL (Carbamazapine), which can cause a rash and can cause bone marrow problems. The use of this medication requires regular blood work.
Surprisingly, one class of medications, the anti-hypertensive (high blood pressure) medications, has shown promise as well in dealing with aggressive behaviours in children with autism. Again, no one knows why these drugs seem to work, since the effects do not seem related to their blood pressure lowering qualities, but for some children with autism they do seem to stem aggressiveness and emotional outbursts.
Of these medications, INDEROL (Propranolol) and VISKEN (Pindolol) both seem to lessen aggression and explosions. Their side effects include a sedative effect, aggravation of asthmatic symptoms and light headedness or fainting due to the reduction of blood pressure. Because of this, the child should be observed closely and a physician consulted if the signs of blood pressure reduction appear.
Lithium had been another medication which was effective in dealing with explosive outbursts and agitation, but its side effects, such as thyroid dysfunction, have led many physicians to no longer use it. Lithium can also cause weight gain, stomach upset and frequent urination. Because of these side effects, it requires close monitoring with regular blood tests and cardiac testing.
All information, data and material contained, presented or provided here is for general information purposes only and is not to be construed as reflecting the knowledge or opinions of Autism Canada, or as providing legal or medical advice. All treatment decisions should be made by the individual in consultation with a licensed health care provider.