Posted by Ame Sans Vie on January 24, 2004, at 11:23:40
In reply to school meds, posted by terrics on January 23, 2004, at 16:16:41
> My students are mentally retarded,...
While I personally am unaware of any medications that are considered useful for this condition, it's important to remember that this handicap almost invariably leads to low self-esteem, anxiety, behavioral management difficulties, and/or affective disorders such as depression. Various forms of non-drug therapy are of great importance, of course -- interpersonal skills, vocational skills, survival skills, coping skills, syndrome-specific coaching (e.g. Parental Advocates for Down Syndrome)... But more often than not, psychotropic drugs are needed to address some of the aforementioned serious issues of emotional health. Depending on their symptom sets, individual biochemistry, and so many other contributing factors, these kids could collectively be taking just about every Rx psychotropic under the sun -- from Aquachloral to bromocriptine to Celexa to dextroamphetamine sulfate to Effexor to fluoxetine HCl to Gabitril to Haldol to Imovane to Janimine to Klonopin to lithium carbonate to meprobamate to Nembutal to Orap to Parnate to quazepam to Remeron to Serzone to trazodone to Ultram to valproic acid to Wellbutrin to Xyrem to yohimbine HCl to Zoloft......... you get the picture, lol. In other words, any SSRI, tricyclic, MAOI, atypical antidepressant, benzodiazepine, barbiturate, other CNS depressant, antimanic, anticonvulsant, neuroleptic, stimulant, dopamine agonist, etc etc etc could be part of their med regimen. And this is not even taking into consideration the multitudes of drugs which the child may take to treat an underlying cause of his retardation. Meningitis, encephalitis, HIV infection, metachromatic leukodystrophy, tuberous sclerosis, Reye's syndrome, hypothyroidism, hypoglycemia/diabetes mellitus, and malnutrition are just a few of many, many causes of developmental disorder, and as you can see, many of these problems require medication of their own.
> emotionally disturbed,...
Well, this may be a sign that the child *needs* some sort of therapy, be it through talk or through chemicals. Depending on exactly what you mean by "emotionally disturbed", there are a million and one different approaches to tackling this issue.
> austic,...
An early-diagnosis and an intense, personalized intervention involving such elements as auditory inegration training, applied behavior analysis, music therapy, occupational therapy, physical therapy, sensory integration, speech/language therapy, and vision therapy vastly improves prognosis in children with pervasive developmental disorders such as autism and Asperger's.
Many medications have been tried, many with some degree of success in certain patients. Here's the breakdown:
~~SSRI antidepressants (Celexa [citalopram HBr], Lexapro [escitalopram oxalate], Paxil/Paxil CR [paroxetine HCl], Zoloft [sertraline HCl], Prozac/Prozac Weekly/Sarafem [fluoxetine HCl], Luvox [fluvoxamine maleate])--in the short-term, they may help by making the child feel more at ease and receptive; hypothesized to cause permanent changes in brain chemistry and structure with longterm use, including growth of new brain cells, as has been recently discovered with Prozac; all of these drugs lower the seizure threshold though, and this is certainly not good news for a population of people prone to seizures -- 30% of autistics develop epilepsy
~~Tricyclic antidepressants--Anafranil (clomipramine) seems to be the most useful of the tricyclics in treating this type of disorder; it works very similarly to the SSRIs, but usually exhibits more side effects; Anafranil also lowers the seizure threshold
~~MAO-inhibiting antidepressants (Aurorix [moclobemide], Nardil [phenelzine], Parnate [tranylcipromine sulfate], Eldepryl [selegiline/deprenyl], Consonar [brofaromine])--Nardil, Parnate, and Eldepryl (at higher doses) increase available serotonin, nor/epinephrine, and dopamine in the brain; Nardil also increases levels of 4-aminobutyric acid (GABA); Parnate causes a bit of catecholamine reuptake inhibition and release due to its active amphetamine metabolites; at low doses, Eldepryl only increases dopamine levels; Consonar and Aurorix only increase levels of serotonin and nor/epinephrine; the result may be similar to that achieved with tricyclics, SSRIs, or other antidepressants, but is generally more profound
~~Edronax (reboxetine) and Strattera (atomoxetine)--inhibit reuptake of norepinephrine; may increase motivation and energy
~~Remeron (mirtazapine)--various effects on norepinephrine and serotonin at specific receptors; often ineffective, and lowers the seizure threshold
~~Serzone (nefazodone)--various actions on norepinephrine and serotonin; also increases levels of two endogenous antihistamines in the blood; lowers the seizure threshold
~~Wellbutrin (bupropion HCl)--inhibits reuptake of dopamine, norepinephrine, and, to a small degree, serotonin; mild CNS stimulant; greatly increases seizure risk
~~Adderall (amphetamine/dextroamphetamine), Dexedrine (dextroamphetamine), Desoxyn (dextromethamphetamine)--inhibit dopamine and norepinephrine reuptake; cause release of dopamine, norepinephrine, and serotonin; strong CNS stimulant, considered by many to be gentler than methylphenidate/dexmethylphenidate; provokes desire for social interaction
~~Cylert (magnesium pemoline)--method of action unknown; lowers seizure threshold; potential for very serious liver problems
~~Ritalin/Ritalin SR/Ritalin LA/Metadate CD/Concerta (methylphenidate HCl) and Focalin (dexmethylphenidate HCl)--similar method of action to amphetamines; tendency to cause anxiety and between-dose jitters; unlike amphetamines, small doses of methylphenidate taken longterm are quite cardiotoxic
~~Benzodiazepine anxiolytics (Ativan/Alzapam/Loraz [lorazepam], Centrax [prazepam], Klonopin/Klonopin Wafers/Rivotril [clonazepam], Librium/Libritabs/Mitran/Resposans-10 [chlordiazepoxide HCl], Serax [oxazepam], Tranxene/Tranxene-SD/Gen-Xene [clorazepate dipotassium], Valium/Valrelease/Diastat/Dizac/Vazepam/Zetran [diazepam], Xanax/Xanax XR [alprazolam], Paxipam [halazepam])--cause disinhibition and may allow the child to open up more, especially coadministered with a stimulant
~~Antifungals (Diflucan [fluconazole], Lamisil [terbinafine HCl], Mycostatin/Mykinac/Nilstat/Nystex [nystatin], Monistat [miconazole], Nizoral [ketoconazole], Sporonax [itraconazole]), antibacterials (Ampligen [poly I: poly C12U], Foscavir [foscarnet sodium/trisodium phosphonoformate], Isoprinosine/Inosiplex/Immunovir [inosine pranobex], Kutapressin [kutapressin/KU], Valtrex [valacyclovir HCl], Venoglobulin S/Polygam/Gammagard [intravenous immunoglobulin/IVIG], Zovirax [acyclovir]) and other drugs (Gastrocom [cromolyn], Habitrol/Nicodern/Nicotrol/ProStep [nicotine], Nitoman/Regulin [tetrabenazine/TDZ], ReVia [naltrexone HCl], Secretin [secretin])--all pretty much experimental at this point
Here is an incomplete list of drugs that may be prescribed if an autistic develops a seizure disorder:
~Cerebyx [fosphenytoin]
~Depakene [sodium valproate/valproic acid]
~Depakote [divalproex sodium]
~Dilantin [phenytoin]
~Lamictal [lamotrigine]
~Phenobarbital/Barbita/Luminal/Solfoton [phenobarbital/phenobarbital sodium]
~Mebaral [mephobarbital/methylphenobarbital]
~Klonopin/Klonopin Wafers/Rivotril [clonazepam]
~Valium/Valrelease/Diastat/Dizac/Vazepam/Zetran [diazepam]
~Tranxene/Tranxene-SD/Gen-Xene [clorazepate dipotassium]
~Mesantoin [mephenytoin]
~Mysoline [primidone]
~Neurontin [gabapentin]
~Peganone [ethotoin]
~Keppra [levetiracetam]
~Gabitril [tiagabine]
~Tegretol [carbamazepine]
~Trileptal [oxcarbazepine]
~Topamax [topiramate]
~Zarontin [ethosuximide]> learning disabled multipli-handicapped and/or have behavior problems.
Behavioral problems and learning disabilities are often an indicator of ADD/ADHD and/or oppositional defiant disorder. Stimulants boast a very high success rate in treating these underlying issues. Most commonly prescribed is methylphenidate HCl (Ritalin, Ritalin LA, Metadate CD, Concerta) which is effective approximately 75% of the time. There is also the right-hand isomer of the methylphenidate molecule (dexmethylphenidate) available as the drug Focalin, which is purported by some to be gentler on the system than racemic methylphenidate.
Next on the list would be any form of amphetamine-based drug. They are about as effective as methylphenidate HCl though often a child (or adult) will respond much more favorably to one than the other. Those in common use in the U.S. are:
~~Dextroamphetamine sulfate -- Dexedrine, Dexedrine Spansules, DextroStat, Das, Dexampex, Oxydess II, Spancap #1, Ferndex
~~Dextromethamphetamine -- Desoxyn, Desoxyn CR
~~Mixed amphetamine salt combo (dextroamphetamine sulfate, amphetamine sulfate, dextroamphetamine saccharate, amphetamine aspartate -- 75% d-amphetamine; 25% l-amphetamine) -- Adderall, Adderall XR (formerly the weight loss aid Obetrol, now repackaged as an extremely effective medication for ADD/ADHD; it tops the list, along with Concerta, of most prescribed medications for this condition)There is one other dopaminergic/adrenergic stimulant sometimes employed to treat these symptoms called Cylert (magnesium pemoline), but it is rarely used due to risk of liver failure.
Some people find relief from the very mild "arousal agent" Provigil (modafinil), normally prescribed for narcolepsy and excessive daytime sleepiness, but this is pretty uncommon.
I'm not sure of the success statistics accompanying the newest ADD/ADHD med, Strattera (atomoxetine), as it's only been available since September 2002. It is a norepinephrine reuptake inhibitor (like the antidepressant Edronax [reboxetine], not available in the U.S.) and is marketed as the first non-stimulant FDA-approved treatment for attention deficit disorder. Along this same vein, sometimes Prozac (fluoxetine HCl -- a potent inhibitor of serotonin reuptake and weak inhibitor of norepinephrine reuptake), Wellbutrin (bupropion HCl -- an inhibitor of dopamine and norepinephrine reuptake; weak serotonin reuptake inhibition) or a tricyclic antidepressant with a primarily noradrenergic action, such as Norpramin (desipramine), Aventyl/Pamelor (nortriptyline), and Vivactil (protriptyline), is used when other avenues have been exhausted or if there is suspicion of stimulant abuse. And it wouldn't be entirely out of place to see certain currently popular weight loss drugs used to treat this condition, as they are, after all, stimulants. Mazanor/Sanorex (mazindol), Meridia (sibutramine), Adipex-P/Fastin/Ionamin/Obenix/Obephen/Oby-Cap/Oby-Trim/Panshape M/Phentercot/Phentride/Pro-Fast HS/Pro-Fast SA/Pro-Fast SR/Teramine/Zantryl (phentermine), Adipost/Anorex-SR/Appecon/Bontril PDM/Bontril Slow-Release/Melfiat/Obezine/Phendiet/Plegine/Statobex/Prelu-2 (phendimetrazine), Didrex (benzphetamine), and Tenuate/Tenuate Dospan (diethylpropion) are all viable options.
Catapres (clonidine), Tenex (guanfacine), and Wytensin (guanabenz), all central alpha-adrenergic agonists normally prescribed as antihypertensives, are often used in conjunction with stimulant medications if the child is experiencing insomnia from the medicine. These drugs seem to work very well as hypnotics under these circumstances.
Finally, if the behavioral problems you speak of include undue anger, aggression, irritability, etc, then Depakene (sodium valproate/valproic acid), Depakote (divalproex sodium), Tegretol (carbamazepine), Trileptal (oxcarbazepine), and Neurontin (gabapentin) are all potentially good candidates to address that issue. Also, the antihypertensive beta-adrenergic blockers Inderal (propranolol), Tenormin (atenolol), and Corgard (nadolol) can all work well at quelling aggression on an as-needed basis.
poster:Ame Sans Vie
thread:304735
URL: http://www.dr-bob.org/babble/20040122/msgs/304977.html