Medications Used to Treat the Symptoms of Autism 

Medications Used to Treat the Symptoms of Autism 

While there is no cure for autism, some symptoms of autism can be managed with medication.  If your doctor is recommending medication but you don’t know much about pharmaceuticals, you may feel unsure about how to handle this important decision.  Below, we describe the medications available for treating autism symptoms.

Risperdal and Abilify (FDA Approved)

Autism and the brain:  In the brain, specialized cells called neurons send signals to each other in order to communicate.  When a neuron is active, it will release certain types molecules known as “neurotransmitters” that bind to other neurons.  When those neurotransmitters bind to other neurons they can make those neurons do a variety of things. There are neurotransmitters that can make neurons less active and there are neurotransmitters that can make neurons more active.  The activity level of neurons is important because it will impact how people experience the world.

For example, when processing sound, loud sounds generally cause neurons to be more active (release excitatory neurotransmitters more frequently) than quiet sounds do.  Or, if you look at it from another way, low neuronal activity might mean that a person is listening to a quiet sound and high levels of activity could mean that the person is listening to a loud sound.  That means that for a person to experience different volumes of sound, it is important that neurons are able to release small, medium, and large amounts of neurotransmitters depending on the loudness of the sound.  If the neurons that respond to sound release a large amount of neurotransmitters in response to a quiet sound, a person might respond to a quiet sound as though it were a loud sound.

Outside the auditory system, changes in how neurons respond can change how people react to the world – they might have a difficult time focusing, over- or under-react to sensations, become agitated or depressed, or a behave in unexpected ways (it’s important to remember that everyone’s brain chemistry is different, so changes in neurochemistry can affect different people in different ways).

Scientists who study the changes in the brain that are associated with autism have found that the brains of autistic people have significant differences in the amounts of certain neurotransmitters present.  In particular, scientists have found differences in the amounts of dopamine and serotonin present in autistic people.  Speaking very broadly, changes in dopamine levels are thought to contribute to the social impairments and stereotyped behaviors seen in autistic people.  Differences in serotonin levels are also thought to contribute to stereotyped behaviors, but may also cause changes in sensory processing.

With information about how dopamine and serotonin can change brain function in mind, the FDA has approved two medications to treat the symptoms of autism.  Those medications are: Risperdal and Abilify.

Risperdal

Other Names: Risperidone

How it Works: Risperdal is a serotonin and dopamine mixed antagonist.  In the context of medications, an antagonist is something that can block the actions of certain neurotransmitters.  In this case, Risperdal blocks the activity of serotonin, which limits the degree to which dopamine-containing neurons can become active in response to serotonergic activity.  Overall, it limits the degree to which dopamine and serotonin can act on neurons.

What it Treats: Irritability, aggression, anxiety

Possible Side Effects:  Drowsiness, weight gain, difficulty sleeping, muscle spasms, difficulty swallowing, difficulty concentrating.  Please visit mayoclinic.org for more details.

Abilify

Other Names: Aripiprazole

How it Works:  The way Abilify works is a little more complicated.  It’s what is called a “partial D2 receptor agonist” which makes it a “dopamine stabilizer.”  When dopamine is released by neurons in the brain, it binds to dopamine receptors on other neurons.  There are different types of dopamine receptors and they cause neurons to do different things when dopamine binds to them.  D2 receptors are a type of dopamine receptor.  Abilify is a D2 agonist, so it mimics dopamine and binds to D2 receptors.  However, Abilify is a what’s called a “partial agonist.”  That means that Abilify will bind to D2 receptors, but then let go of the receptor before binding again (and continue the pattern of binding and releasing while present in the brain).  That “on-off” method of D2 receptor binding means that Abilify will keep neurons that are overly responsive to dopamine from becoming fully activated, and keep neurons that are under responsive to dopamine partially activated.  By tapping down the activity of neurons that over-react to dopamine and increasing the activity of cells that under-react to dopamine, Abilify is able to stabilize degree to which dopamine can activate neurons.

What it Treats:  Depression, irritability

Possible Side Effects:  Nausea and vomiting, headache, constipation, weight gain, insomnia, abnormal movements, changes in blood pressure.  Please visit mayoclinic.org for more details.

Notes: Aripiprazole interacts with several other psychoactive medications so using it may limit you or your child’s other therapeutic options.

What Food and Drug Administration (FDA) Approval Means

You or your child may be prescribed Risperdal, Abilify, or any in a range of off-label medications.  Since autistic people may take FDA approved medications or off-label medications, does FDA approval matter?

FDA approval means that the FDA has had scientific testing performed on a certain medication to determine 1) what dosages are safe, and 2) whether the proposed use for the drug is worth the side effects.  If a drug is used off label, it usually means that the drug is being used for a group of people for whom drug testing was not performed.  FDA testing is generally done using adults, so the instructions on how to use a certain medication usually describes how adults should use the medication.  A medication may be used off-label for children, pregnant people, or for any group that was not included in the FDA testing for a specific drug.  Off-label medication use is generally safe when done under the supervision of a doctor, but it is important to remember that 1) children’s brains are still developing so they may respond to medications differently than adults, and 2) even within adult populations different people have different reactions to drugs.

When you or your child is taking any medication, it is always important to monitor side effects and report them to your doctor.  Since many autistic children are non-verbal or have limited language use, it is important to watch for behavioral changes (such as increased irritability), as they may not be able to describe how they are feeling directly.  Similarly, if they experience an unexpected side effect, report it to your doctor.  If you or your child have been prescribed an off-label medication, you can also ask your doctor what anecdotal evidence supports its use for the symptoms of autism.

IMPORTANT:  Treating the symptoms of autism with medications probably won’t be a “one and done” process.  Some medications take time to work and medication dosages may need to be adjusted several times before finding the right fit.  While these setbacks might be frustrating in the short term, remember that finding the right medication at the right dose can improve you or your child’s life in the long term.  Hang in there!  Talk to your doctor about what seems to work well and what does not as often as possible.

Other Common Medications Used for Treating Autism Symptoms

Selective Serotonin Re-uptake Inhibitors (SSRIs):

SSRIs are a class of medications that can stabilize someone’s mood by changing serotonin activity in the brain.  They are typically used as a treatment for depression.  SSRIs are not used for autism as frequently as they once were, but fluoxetine (also known as Prozac) and sertraline (also known as Zoloft) may still be prescribed.

Use: Treating anxiety and depression in people with autism.  SSRIs are sometimes used to treat self-injurious behavior, aggression, and repetitive behaviors in autism, but the effectiveness of SSRIs for those conditions is debated.

Side Effects:  Agitation, anxiety, GI issues, weight changes, dizziness, and dry mouth

For more information, please see:

https://psychcentral.com/autism/medications-for-autism#ssr-is

National Library of Medicine Resource!

https://www.nichd.nih.gov/health/topics/autism/conditioninfo/treatments/medication-treatment

Tricyclics:

Tricyclics are another type of antidepressant medication used to treat depression and obsessive-compulsive behaviors.  Tricyclics work on a variety of systems in the brain.  They increase the amount of time that serotonin and norepinephrine (a neurotransmitter) can act on neurons and they block acetylcholine and histamine (two different neurotransmitters) activity in the brain. The most commonly used tricyclics for autism are amitriptyline (also known as Elavil), clomipramine (also known as Anafranil), and desipramine (also known as Norpramin).

Use:  For autistic people, tricyclics can be used to treat irritability, hyperactivity, and inappropriate speech.

Side Effects:  Tricyclics have more side effects than other anti-depressants (like SSRIs), so they usually aren’t used unless other medications have been proven ineffective.  Side effects for tricyclics include weight gain, dry mouth, dry eyes, constipation, and drowsiness.

For more information, please see:

https://psychcentral.com/autism/medications-for-autism#tricyclics

https://www.nichd.nih.gov/health/topics/autism/conditioninfo/treatments/medication-treatment

National Library of Medicine Resource! https://www.ncbi.nlm.nih.gov/books/NBK557791/

Antipsychotic Medications:

The name “antipsychotic” can sound scary, but for the purposes of treating autism, antipsychotics may be used to reduce irritability.  Risperidone (Risperdal) and aripiprazole (Abilify) are both antipsychotic medications and are the only medications approved by the FDA to treat autism symptoms (please see Risperdal and Abilify sections above).  As with Risperdal and Abilify, other antipsychotics work by stabilizing the activity of serotonin and dopamine.  Although Risperdal and Abilify are the only FDA approved medications for autism, there are other antipsychotics that might be used to treat the symptoms of autism, including: clozapine (also known as Clozaril), olanzapine (also known as Zyprexa), and quetiapine (also known as Seroquil).

Use:  Treats irritability in people with autism.

Side Effects: Weight gain, tremors, drowsiness

For more information, please see:

https://psychcentral.com/autism/medications-for-autism#antipsychotics

National Library of Medicine Resource!

https://www.ncbi.nlm.nih.gov/books/NBK519503/

Stimulants:

Stimulants are typically prescribed when a child with autism also shows signs of attention deficit hyperactivity disorder (ADHD).  Stimulants used to treat ADHD (and ADHD in autism) fall into different categories – two of the most commonly prescribed categories are amphetamine salts (also known as Adderall) and methylphenidate (Ritalin).  Methylphenidate is an FDA approved medication for treating ADHD.  It works by magnifying the activity of norepinephrine and dopamine (two types of neurotransmitters).  As such, methylphenidate has a stimulant effect throughout the brain, particularly in the prefrontal cortex (the part of the brain that controls decision making and executive functioning) which may be underactive in ADHD.  Similarly, amphetamine salts stimulate the brain by increasing the amounts of dopamine, norepinephrine, and serotonin available to neurons.

Use: Improve focus, minimize hyperactivity

Side Effects: Insomnia, nervousness, dizziness, restlessness, tics, weight loss, reduced appetite, nausea, dry mouth, and addiction.

Important:  If stimulants are mis-prescribed or given in the wrong dose, symptoms may worsen.  Children may become aggressive and/or have violent meltdowns.  Please note that children should be at least 6 years of age before beginning treatment with methylphenidate.

For more information, please see:

https://psychcentral.com/autism/medications-for-autism#stimulants

National Library of Medicine Resource!

https://www.ncbi.nlm.nih.gov/books/NBK482451/

National Library of Medicine Resource!

https://www.ncbi.nlm.nih.gov/books/NBK556103/

Anxiolytic Medications (Anti-Anxiety Medications):

Anxiety is common in autistic people and might manifest as generalized anxiety, social anxiety, panic attacks, or even obsessive-compulsive disorder.  Anxiolytic medications maybe prescribed as a stand-alone treatment, but ideally they are given in combination with psychological treatment for anxiety.  Some commonly prescribed anti-anxiety medications are: sertraline (also known as Zoloft), fluoxetine (also known as Prozac), clonidine (also known as Catapres), citalopram (also known as Celexa), and escitalopram (also known as Lexapro).

Use: Treats anxiety

Side Effects:  Headaches, dizziness, drowsiness, nausea, upset stomach, constipation

For more information:

https://psychcentral.com/autism/medications-for-autism#anti-anxiety-medications

Anticonvulsants (Anti-seizure medication):

Sometimes, people with autism also experience seizures.  Essentially, seizures happen when neurons in the brain begin to fire in an uncontrolled manner.  Therefore, some of the medications for controlling seizures seek to limit the degree to which neurons can fire.  Carbamazepine (also known as Tegretol), clonazepam (also known as Klonopin), topiramate (also known as Topamax), and lamotrigine (also known as Lamictal) all limit neuronal activation.  Other types of medication, such as diazepam (also known as Valium), work by enhancing the activity of GABA, an important inhibitory neurotransmitter.

Use: Prevent seizures, reduce seizure severity, reduce frequency of seizures

Side Effects: Weight gain, drowsiness, headaches, disrupted sleep, upset stomach, aggression

For more information, please see:

https://psychcentral.com/autism/medications-for-autism#anti-seizure-medications

National Library of Medicine Resource!

https://www.ncbi.nlm.nih.gov/books/NBK430765/

National Library of Medicine Resource!

https://www.ncbi.nlm.nih.gov/books/NBK482269/

Sleep Aids:

Disrupted sleep is a frequent complaint in autism.  Melatonin is a commonly used sleep aid for autistic children.  It works by supplementing the melatonin children’s brains normally produce in order to help them fall asleep at night.  While melatonin is technically a dietary supplement, and therefore not regulated by the FDA, it is the preferred first-line treatment for insomnia by the American Academy of Family Physicians, as it has few side effects.  If melatonin doesn’t achieve the desire result, doctors may also prescribe medications such as Clonidine, Guanfacine, or Trazodone.

Use: Aids in falling aside and staying asleep

Side Effects: drowsiness, daytime sleepiness, headaches, nausea, dizziness,

hypotension, bradycardia, irritability

For more information, please see:

National Library of Medicine Resource!

https://www.ncbi.nlm.nih.gov/books/NBK534823/

National Library of Medicine Resource!

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6313590/

For more information about using medications to treat the symptoms of autism, please see our “Autism Medications Cheat Sheet” article. 

Article by: The Autism ToolKit

References:

Arky, B. (2022, March 29). Autism and Medication. Child Mind Institute. Retrieved January 9, 2023, from https://childmind.org/article/autism-and-medication/

Medication Treatment for Autism. NICHD. (2021, April 19). Retrieved January 9, 2023, from https://www.nichd.nih.gov/health/topics/autism/conditioninfo/treatments/medication-treatment

Regan, T. (2022, April 6). The Medications Used to Treat Autism Spectrum Disorder. Additute: Inside the ADHD Mind. Retrieved January 9, 2023, from https://www.additudemag.com/autism-treatment-medication-options/