A Retrospective Study of Amitriptyline in Youth with Autism Spectrum Disorders

Bhatti, Irfan; Thome, Andrew P.; Smith, Patricia Oxler; Gaffney, Gary R.; Hellings, Jessica A.

doi:10.1007/s10803-012-1647-0

Cited by 15 publications

(4 citation statements)

References 40 publications

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“…A retrospective chart review of 50 CA with ASD and hyperactivity and impulsivity who have been prescribed amitriptyline (mean dose of 1.3 mg/kg/day). The results showed that 60% of the participants improved in their CGI-I scores 149 . The use of brain-derived neurotropic factor stimulators, such as loxapine or amitriptyline, deserves further study 150 …”

Section: Future Directionsmentioning

confidence: 99%

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Off-label psychopharmacological interventions for autism spectrum disorders: strategic pathways for clinicians

Gupta¹,

Gupta²

2023

CNS Spectr.

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The prevalence of autism spectrum disorder (ASD) continues to see a trend upward with a noticeable increase to 1 in 36 children less than 8 years of age in the recent MMWR. There are many factors linked to the substantially increased burden of seeking mental health services, and clinically these individuals are likely to present for impairments associated with co-occurring conditions. The advances in cutting-edge research and the understanding of co-occurring conditions in addition to psychosocial interventions have provided a window of opportunity for psychopharmacological interventions given the limited availability of therapeutics for core symptomatology. The off-label psychopharmacological treatments for these co-occurring conditions are central to clinical practice. However, the scattered evidence remains an impediment for practitioners to systematically utilize these options. The review collates the crucial scientific literature to provide stepwise treatment alternatives for individuals with ASD; with an aim to lead practitioners in making informed and shared decisions. There are many questions about the safety and tolerability of off-label medications; however, it is considered the best practice to utilize the available empirical data in providing psychoeducation for patients, families, and caregivers. The review also covers experimental medications and theoretical underpinnings to enhance further experimental studies. In summary, amidst the growing clinical needs for individuals with ASD and the lack of approved clinical treatments, the review addresses these gaps with a practical guide to appraise the risk and benefits of off-label medications.

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Section: Future Directionsmentioning

confidence: 99%

“…The results showed that 60% of the participants improved in their CGI-I scores. 149 The use of brain-derived neurotropic factor stimulators, such as loxapine or amitriptyline, deserves further study. 150 NMDA receptor antagonists memantine and amantadine have also been studied.…”

Section: Future Directionsmentioning

confidence: 99%

Off-label psychopharmacological interventions for autism spectrum disorders: strategic pathways for clinicians

Gupta¹,

Gupta²

2023

CNS Spectr.

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“…Drug therapies for mood disorders in ASD have included SSRIs and SNRIs (selective serotonin or norepinephrine reuptake inhibitors) ( Henry et al, 2009 ; Nanjappa et al, 2020 ). Amitriptyline, which also affects norepinephrine reuptake, has been used to treat hyperactivity and impulsivity in ASD ( Bhatti et al, 2013 ). One possible interpretation is inadequate production of serotonin and/or norepinephrine in ASD, or abnormalities in the receptors for those transmitters.…”

Section: What Do We Know About the Brain In Asd: Candidate Structures And Their Connectionsmentioning

confidence: 99%

Functional and Neuropathological Evidence for a Role of the Brainstem in Autism

Baizer

2021

Front. Integr. Neurosci.

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The brainstem includes many nuclei and fiber tracts that mediate a wide range of functions. Data from two parallel approaches to the study of autistic spectrum disorder (ASD) implicate many brainstem structures. The first approach is to identify the functions affected in ASD and then trace the neural systems mediating those functions. While not included as core symptoms, three areas of function are frequently impaired in ASD: (1) Motor control both of the limbs and body and the control of eye movements; (2) Sensory information processing in vestibular and auditory systems; (3) Control of affect. There are critical brainstem nuclei mediating each of those functions. There are many nuclei critical for eye movement control including the superior colliculus. Vestibular information is first processed in the four nuclei of the vestibular nuclear complex. Auditory information is relayed to the dorsal and ventral cochlear nuclei and subsequently processed in multiple other brainstem nuclei. Critical structures in affect regulation are the brainstem sources of serotonin and norepinephrine, the raphe nuclei and the locus ceruleus. The second approach is the analysis of abnormalities from direct study of ASD brains. The structure most commonly identified as abnormal in neuropathological studies is the cerebellum. It is classically a major component of the motor system, critical for coordination. It has also been implicated in cognitive and language functions, among the core symptoms of ASD. This structure works very closely with the cerebral cortex; the cortex and the cerebellum show parallel enlargement over evolution. The cerebellum receives input from cortex via relays in the pontine nuclei. In addition, climbing fiber input to cerebellum comes from the inferior olive of the medulla. Mossy fiber input comes from the arcuate nucleus of the medulla as well as the pontine nuclei. The cerebellum projects to several brainstem nuclei including the vestibular nuclear complex and the red nucleus. There are thus multiple brainstem nuclei distributed at all levels of the brainstem, medulla, pons, and midbrain, that participate in functions affected in ASD. There is direct evidence that the cerebellum may be abnormal in ASD. The evidence strongly indicates that analysis of these structures could add to our understanding of the neural basis of ASD.

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“…A short-term treatment of tianeptine showed a modest effect on irritability in 12 children with ASD [25]. Low-dose amitriptyline has also shown promise in youth with ASD for hyperactivity and impulsivity [26]. However, no large randomized clinical trials have been conducted till date with TCAs for treatment of ASD.…”

Section: Review Articlementioning

confidence: 99%

Pharmacobiological Treatments in Autism Spectrum Disorders

Jayaraman¹,

Mundkur²

2017

IJCRR

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Autism spectrum disorders (ASD) refer to a group of neuro-developmental disorders affecting young children and adults. Currently, the treatment options for ASD are mostly restricted to treating its symptoms. Among the various approaches for treating ASD, pharmacobiology-based treatments are numerous. Our objective is to review the up-to-date information on different types of medications and briefly discuss the evidence-based potential of these treatments in ASD therapy. PubMed searches for reports and reviews on clinical data from the last 15 years, between 2002-2017, using search terms of each category of treatment along with the terms "autism", "mechanism", and/or "side effects" were conducted. Several pharmacobiological interventions have been prescribed for ASD, including antipsychotics, stimulants, antidepressants, supplements, and special diets. However, none of these methods is an effective ASD treatment, and only few show much promise. We provide a brief overview of the current pharmacobiological treatments for ASD, their mechanisms of action, and clinical research-based evidence on their effectiveness. Based on our review, we recommend that caution should be exercised when choosing a pharmacobiological treatment method for ASD as majority of existing evidence is not from large-scale long-term high quality studies.Future research should focus on rigorous investigative design, long-term implementation, and meaningful uniform outcome measurements.

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A Retrospective Study of Amitriptyline in Youth with Autism Spectrum Disorders

Cited by 15 publications

References 40 publications

Off-label psychopharmacological interventions for autism spectrum disorders: strategic pathways for clinicians

Off-label psychopharmacological interventions for autism spectrum disorders: strategic pathways for clinicians

Functional and Neuropathological Evidence for a Role of the Brainstem in Autism

Pharmacobiological Treatments in Autism Spectrum Disorders

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