Pharmacotherapy in autism spectrum disorders, including promising older drugs warranting trials

doi:10.5498/wjp.v13.i6.262

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Jun 19, 2023 (publication date) through Mar 5, 2026

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World Journal of Psychiatry

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2220-3206

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Psychiatry. Jun 19, 2023; 13(6): 262-277
Published online Jun 19, 2023. doi: 10.5498/wjp.v13.i6.262

Pharmacotherapy in autism spectrum disorders, including promising older drugs warranting trials

Jessica Hellings

Jessica Hellings, Department of Psychiatry, University of Missouri-Kansas City, Lee's Summit, MO 64063, United States

Author contributions: Hellings J is responsible for all contributions to this manuscript.

Conflict-of-interest statement: The author has been an investigator for Janssen Pharmaceuticals, Abbott Laboratories, Forest Laboratories, Supernus, Young Living Essential Oils, NIMH and NICHD. NICHD previously funded a risperidone program project grant with the author as principal investigator of the drug study project. The author currently has internal funding from University of Missouri-Kansas City to study amitriptyline in ASD.

Corresponding author: Jessica Hellings, MB.BCh., MMed, Professor, Department of Psychiatry, University of Missouri-Kansas City, 300 SE Second St, Lee's Summit, MO 64063, United States. jessica.hellings@uhkc.org

Received: December 28, 2022
Peer-review started: December 28, 2022
First decision: February 21, 2023
Revised: March 6, 2023
Accepted: April 18, 2023
Article in press: April 18, 2023
Published online: June 19, 2023
Processing time: 172 Days and 12.1 Hours

Core Tip

Core Tip: Most prescribing in autism spectrum disorders (ASD) is off-label; only risperidone and aripiprazole are Federal Drug Administration-approved in ASD, for irritability. Atypical antipsychotics are associated with metabolic side effects. Loxapine at 5-10 mg/day resembled an atypical antipsychotic in positron emission tomography studies; preliminary studies and clinical experience in ASD suggest efficacy and a promising metabolic profile. Controlled attention deficit hyperactivity disorder (ADHD) medication trials in ASD youth include methylphenidate, atomoxetine and guanfacine. The author recommends dextroamphetamine as an important treatment option for ADHD in ASD. Amitriptyline often improves impulsive aggression, self-injury, sleep, anxiety and enuresis. This article recommends additional older drug trials in ASD: Detroamphetamine, amitriptyline, loxapine, and lamotrigine for likely seizures.