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

Abstract

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.

SSRI Behavioral Activation, the Boxed Bolded Warning, and Neurodevelopmental Disorders

“…At the same time, there are off-label options with atypical mechanisms of action like buspirone and mirtazapine. 35 Lastly, an overwhelming preponderance of nuanced contrarian evidence calls for reinvestigating the boxed warning for SSRIs. 1 While boxed warnings served their purpose, incorporating emerging evidence to develop improved guidance would foster an alliance among stakeholders critical for public health partnerships.…”

New advances in the diagnosis and treatment of autism spectrum disorders

“…The decision to medicate should be based on an individualized assessment that takes into account the patient’s specific needs, the severity of symptoms, and possible side effects. At the same time, pharmacological treatments are often used in combination with non-pharmacological treatments such as behavioral interventions and educational support to achieve optimal therapeutic outcomes [ 50 ].…”

Exploratory focused pharmacogenetic testing reveals novel markers associated with risperidone pharmacokinetics in Saudi children with autism

“…Additionally, off-label antipsychotic use is still an ongoing clinical practice, despite the lack of evidence for its safety and tolerability ( Højlund et al, 2021 ; Wang et al, 2021 ; Carthy et al, 2023 ). This practice was thought to be justified given the shortage of approved clinical cures and was even found to be motivated by advancements in diagnostic and clinician recognition of disparity in ASD and cooccurring mental health issues ( Gupta and Gupta, 2023 ).…”