What medications are used to manage irritability and mood swings in individuals with Autism Spectrum Disorder (ASD)?

From the Guidelines

Medications such as risperidone are used to manage irritability and mood swings in individuals with Autism Spectrum Disorder (ASD), as they have shown efficacy in reducing physical aggression and severe tantrum behavior 1. When managing irritability and mood swings in ASD, it's crucial to consider the individual's specific needs and target symptoms.

• Pharmacologic interventions, including risperidone, may be offered to children with ASD when there is a specific target symptom or comorbid condition, such as anxiety or depression 1.
• The goal of treatment is not only to reduce symptoms but also to facilitate the child's adjustment and engagement with educational intervention.
• Combining medication with parent training is moderately more efficacious than medication alone for decreasing serious behavioral disturbance and modestly more efficacious for adaptive functioning 1. Some key considerations for treatment include:
• Starting with low doses and gradually increasing based on response and side effects
• Monitoring treatment response using objective rating scales and caregiver reports
• Individualizing treatment and adjusting as needed
• Considering non-medication approaches, such as behavioral therapy and establishing routines, alongside medication
• Regular follow-ups to assess effectiveness and side effects, such as weight gain, sedation, or metabolic changes 1.

From the FDA Drug Label

RISPERIDONE is indicated for the treatment of irritability associated with autistic disorder, including symptoms of aggression towards others, deliberate self-injuriousness, temper tantrums, and quickly changing moods Efficacy was established in 3 short-term trials in children and adolescents (ages 5 to 17 years) [see Clinical Studies ( 14.4)].

Risperidone is used to manage irritability and mood swings in individuals with Autism Spectrum Disorder (ASD), including symptoms such as:

• Aggression towards others
• Deliberate self-injuriousness
• Temper tantrums
• Quickly changing moods 2

From the Research

Medications for Irritability and Mood Swings in ASD

• Selective serotonin reuptake inhibitors (SSRIs) have been used to treat irritability and mood swings in individuals with Autism Spectrum Disorder (ASD) 3, 4, 5.
• Low-dose fluoxetine has been shown to improve self-injurious behavior, ADHD-like symptoms, and irritability in children with ASD 3.
• Risperidone has been used to treat mood disorders and aggressive behavior in children, including those with ASD, with moderate to marked improvement in 7 out of 8 children 6.
• Selective serotonin and norepinephrine reuptake inhibitors (SNRIs) have also been used to treat symptoms of ASD, with venlafaxine showing promise in reducing self-injurious behaviors, aggression, and ADHD symptoms 7.
• Milnacipran has been reported to improve impulsivity, hyperactivity symptoms, and social functioning in individuals with ASD and comorbid ADHD 7.

Specific Medications and Their Effects

• Fluoxetine: improves self-injurious behavior, ADHD-like symptoms, and irritability in children with ASD 3.
• Risperidone: improves mood disorders and aggressive behavior in children, including those with ASD 6.
• Venlafaxine: reduces self-injurious behaviors, aggression, and ADHD symptoms in children and adults with ASD 7.
• Milnacipran: improves impulsivity, hyperactivity symptoms, and social functioning in individuals with ASD and comorbid ADHD 7.
• Citalopram: shows no evidence of positive effect in children with ASD, but may have limited effectiveness in adults with ASD 4, 5.