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Selective Serotonin Reuptake Inhibitors (SSRIs) as a Treatment for Autism
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Last Updated: July 14, 2003

Serotonin Imbalance in Autism

Neurotransmitters are powerful chemical messengers that carry messages to and from the brain. These messages are everything that you do, think, say, feel, hear, smell, touch, and taste. The main neurotransmitters are serotonin, norepinephrine, and dopamine.

An imbalance in serotonin is believed to cause many of the characteristic symptoms of autism. This serotonin imbalance can lead to sleep disturbances, speech delays, and sensory integration problems, as serotonin regulates

*sensory integration
*body temperature

This imbalance occurs when the neurotransmitter serotonin doesn't properly carry the message to the proper portion of the brain. Rather, the serotonin is prematurely 'swept away' for reuse in the re-uptake process before the brain has a chance to receive and make sense of the incoming messages.

For example, if I tell you "Go close the door," neurotransmitters carry the sound of my voice from your ear to the portion of your brain that understands language in order for you to make sense of what I've said. This is auditory processing...the brain processing the sounds that the ear detects.

Many children with autism, however, have great difficulty with auditory processing because the neurotransmitters aren't properly carrying the sounds from the ear to the correct portion of the brain. Many autistic children also have difficulty with sensory integration for the same reason: they don't perceive sensations the way 'typical' children do because the messages aren't carried properly to the brain. Before the message is received and processed, it is swept away in the reuptake process.

It is often difficult for autistic children to discern what is important stimuli and what is not, or which sensation they should focus on and which they should tune out. The serotonin imbalance makes it extremely difficult for them to tune out unnecessary stimulation. The result can be self-stimulation, or repetitve actions such as rocking, spinning, and hand-flapping that the child performs to help calm themselves from the flurry of stimulation that they are unable to tune out.

Because the messages aren't properly delivered, some things they should notice they don't notice at all, such as when a parent calls out her child's name and the child seems not to hear the parent at all. Many parents of autistic children report initially thinking their child had a hearing impairment, only to discover their child's hearing falls into normal ranges upon having a hearing evaluation. Often, the problem is not with the child's hearing; rather, it is with the neurotransmitters not carrying the sounds from the ear to the brain properly. They are not 'tuning in' to their parents because of all the other stimuli that has grabbed their attention.

It is often difficult for them to tune certain things out, such as the sound of a flickering fluorescent light or constant motion of a ceiling fan. This is the result of a neurotransmitter failing to complete its job to deliver messages to and from the brain, leaving the child unable to discern which stimuli s/he should attend to and which stimuli can be tuned out.

Sometimes, everyday sounds are exaggerated for them, actually causing them discomfort and possibly pain, such as the sound of the toilet flushing or the whir of a hair dryer (which Temple Grandin claimed sounded to her like a jet plane). It is believed that this sound sensitivity is caused by serotonin imbalance.

Another major problem often seen in autism is sleep disturbance . The neurotransmitter serotonin also regulates the release of melatonin, the body's natural sleep aid that helps establish a sleep cycle. My three-year-old autistic son was locked into a pattern of taking naps at 8:00 pm and finally going to sleep at 3:00 a.m. every night. Nothing I did seemed to help him. It didn't matter if I woke him up early or tried to keep him up from his nap. Attempts to get him to bed at a decent hour made everyone miserable, as he would yell and keep everyone awake.

My son's problem was with his body's release of melatonin at inappropriate times. His body was literally keeping him awake until those late hours in the morning. This was a result of a serotonin imbalance.

A serotonin imbalance in autism as described here can lead to

*Sensory Integration Problems
*Auditory Processing Problems
*Speech Delays
*Repetitive Behaviors
*Sleep Disturbances

Many professionals believe that one way to successfully help treat these problems that are typical in autism is to use Selective Serotonin Reuptake Inhibitors.

Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs are anti-depressant medications used to treat a variety of conditions, including depression, anxiety, and autism. Its purpose is to block the reuptake of serotonin, an important neurotransmitter in the brain that helps regulate sleep, mood, appetite, sensory integration, and body tempterature regulation. It helps to keep the serotonin in the brain longer rather than being prematurely cleared out (the reuptake process)

A good trial for an SSRI is 10 weeks. It takes at least 30 days for the drug to get fully into your system and for you to see the results of the medication. You might be able to notice a difference on the drug with the first week; you might not see the full range of side effects (such as drowsiness) for two months.

SSRIs are commonly prescribed for children with autism, even at the age of two years old. In autism, SSRIs can help dramatically with sensory integration problems, as well as problems with obsessive compulsive disorder, sleep problems, and irritability (what we parents of autistic children often refer to as "meltdowns").

One thing to keep in mind when trying an SSRI: you might see an increase in aggressive behaviors the first couple of weeks on the medication. Serotonin helps regulate sensory integration, so the processing of sensory input is changing (improving) with the addition of an SSRI.

In my experience, this aggressive behavior was temporary, lasting only a couple of weeks. Be sure and inform the doctor of this aggression, as he may wish to alter the dose of meds or to temporarily add another med such as Risperdol for the aggression during the transition onto the SSRI.

Currently, there are six SSRIs available on the market:

* Prozac (fluoxetine; Eli Lily)
* Celexa (citalopram; Forest Pharmaceuticals)
* Luvox (fluvoxamine; Solvay)
* Zoloft (sertraline; Pfizer)
* Paxil (paroxetine; GlaxoSmithKline)
* Lexapro (escitalopram; Forest Pharmaceuticals)

Prozac (fluoxetine; Eli Lily)

FDA Approves Prozac for Pediatric Use to Treat Depression and OCD, an FDA Talk Paper January 3, 2003

Prozac Home Page

What Medications are Available for Autism? Prozac? from the National Institute for Mental Health and Prozac/PDD Websites

Prozac Information from Internet Mental Health

Prozac Information from RxList

Prozac Description from Health Square/PDR Guide to Medications

ABSTRACT: Prozac and Pregnancy/Lactation: Pharmacokinetics of fluoxetine and norfluoxetine in pregnancy and lactation, from Clin Pharmacol Ther. 2003 Apr;73(4):330-7.

Autism medications systematically measured in children (American Journal of Psychiatry)

Randomized Study of Fluoxetine in Children and Adolescents With Autism

Study of Fluoxetine in Adults With Autistic Disorder

The Seaver Center for Autism Research and Treatment

Treatment of Comorbid Disorders in Autism: Which Regimens Are Effective and for Whom?

Celexa (citalopram; Forest Pharmaceuticals)

Celexa Home Page

ABSTRACT: Citalopram treatment of children and adolescents with obsessive-compulsive disorder: A preliminary report, from Psychiatry Clin Neurosci. 2003 Aug;57(4):405-8

ABSTRACT: Use of citalopram in pervasive developmental disorders, from J Dev Behav Pediatr. 2003 Apr;24(2):104-8.

Celexa Description from Health Square/PDR Guide to Medications

ABSTRACT: Celexa for PDD: Use of citalopram in pervasive developmental disorders, from : J Dev Behav Pediatr. 2003 Apr;24(2):104-8

ABSTRACT: Celexa vs. Prozac: Citalopram Effective in Patients Who React Adversely to Fluoxetine, from Journal of Clinical Psychiatry 06/05/2003

Luvox (fluvoxamine; Solvay)

ABSTRACT: Treatment with fluvoxamine against self-injury and aggressive behavior in autistic children

Luvox Description from Health Square/PDR Guide to Medications

ABSTRACT: Low-dose fluvoxamine treatment of children and adolescents with pervasive developmental disorders: a prospective, open-label study, from J Autism Dev Disord. 2003 Feb;33(1):77-85.

ABSTRACT: A double-blind, placebo-controlled study of fluvoxamine in adults with autistic disorder, from Arch Gen Psychiatry. 1996 Nov;53(11):1001-8.

Autism medications systematically measured in children (American Journal of Psychiatry)

Zoloft (sertraline; Pfizer)

Zoloft Home Page

Zoloft Description from Health Square/PDR Guide to Medications ABSTRACT: Sertraline treatment of transition-associated anxiety and agitation in children with autistic disorder, from J Child Adolesc Psychopharmacol. 1997 Spring;7(1):9-15.

Sertraline hepatotoxicity, from Dig Dis Sci. 2003 May;48(5):939-44

ABSTRACT: Sertraline response in adults with mental retardation and autistic disorder, from : J Clin Psychiatry. 1996 Aug;57(8):333-6.

ABSTRACT; Zoloft and Mania: Sertraline-induced hypomania: a genuine side-effect, from Acta Psychiatr Scand. 2003 Jul;108(1):70-4.

ABSTRACT: Sertraline-induced hypomania: a genuine side-effect, from Acta Psychiatr Scand. 2003 Jul;108(1):70-4.

ABSTRACT: Association of a critical CSF tryptophan threshold level with depressive relapse, from Neuropsychopharmacology. 2003 May;28(5):956-60.

ABSTRACT: The effect of sertraline on cognitive functions in patients with obsessive-compulsive disorder from Psychiatr Pol. 2002 Nov-Dec;36(6 Suppl):289-95

Paxil (paroxetine; GlaxoSmithKline)

Generic Paxil Approved by FDA

Latest News on Paxil

FDA Statement Regarding the Anti-Depressant Paxil for Pediatric Population, Issued June 19, 2003

FDA and Paxil: Questions and Answers about FDA's Stance on Pediatric Use of Paxil; Posted June 19, 2003

Paxil Home Page

Paxil Description from Health Square/PDR Guide to Medications

ABSTRACT: Focus on paroxetine, from Curr Med Res Opin. 2003;19(1):13-21

Lexapro (escitalopram; Forest)

Lexapro Home Page

ABSTRACT: Mechanisms of action of antidepressants: new data from Escitalopram, from Encephale. 2003 May-Jun;29(3 Pt 1):259-65

Lexapro Description from Health Square/PDR Guide to Medications

Articles and Abstracts on the Use of SSRIs for Autism

Antidepressants Can Break Through The Wall of Many Children's Autism, Duke Researchers Say, by Duke University Medical Center News Office

Studies of the Pharmacological Treatment of Autism: Serotonin Reuptake Inhibitors, by NAMI (The National Alliance of the Mentally Ill)

Common Medications Used to Treat Autism: Control of Self-Injurious and Stereotypical Behaviors: SSRI's and Opioid Antagonists, by

Medications for Pervasive Developmental Disorders

Medication as Treatment for Autism

ABSTRACT: Therapeutic effects and long-term efficacy of antidepressant medication for persons with developmental disabilities, from Behav Modif. 2001 Jan;25(1):62-78.

ABSTRACT: A double-blind comparison of clomipramine, desipramine, and placebo in the treatment of autistic disorder, from Arch Gen Psychiatry. 1993 Jun;50(6):441-7.

ABSTRACT: Problems of current antidepressant drugs, from Nihon Shinkei Seishin Yakurigaku Zasshi. 2003 Apr;23(2):61-5 [Article in Japanese]

Effect of Antidepressants and Their Relative Affinity for the Serotonin Transporter on the Risk of Myocardial Infarction from Circulation. 2003 Jun 23

Advice on the use of Prozac and other SSRI antidepressant drugs in Autism/PDD by Dr. Joe Huggins



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Basic Information
For Those New to the Diagnosis of Autism: The First Things to Do and the Initial Visit to the Neurologist
What Is Autism, PDD, and Asperger's Syndrome?
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Therapies and Treatments
Sensory Integration
Applied Behavioral Analysis
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Diet and Nutrition
Vision Therapy and Autism

Medication Use and Autism
Selective Serotonin Reuptake Inhibitors (SSRIs) as a Treatment for Autism
A Parent's Decision to Use an SSRI for her Young Autistic Son
Sleep Problems with Autism and Other Related Conditions
Risperdal and Other Atypical Neuroleptics as a Treatment for Autism

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Sign Language
PECS and Other Picture Communication Systems

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