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Use of selective serotonin and norepinephrine reuptake inhibitors (SNRIs) in the treatment of autism spectrum disorder (ASD), comorbid psychiatric disorders and ASD-associated symptoms: a clinical review

Published online by Cambridge University Press:  07 December 2020

Muralidhara Shankarapura Nanjappa ,
Emanuel Voyiaziakis ,
Basant Pradhan  and
Srinagesh Mannekote Thippaiah Open the ORCID record for Srinagesh Mannekote Thippaiah [Opens in a new window]
Muralidhara Shankarapura Nanjappa
Affiliation:
Child and Adolescent Psychiatry, Park Nicollet Specialty Center, Saint Louis Park, Minnesota, USA
Emanuel Voyiaziakis
Affiliation:
Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Glen Oaks, New York, USA
Basant Pradhan
Affiliation:
Psychiatry and Pediatrics, Cooper Medical School of Rowan University, Camden, New Jersey, USA
Srinagesh Mannekote Thippaiah*
Affiliation:
Psychiatry, Creighton University School of Medicine-Phoenix Campus Valley wise Behavioral Health CenterPhoenixAZ
*
*Author for correspondence: Srinagesh Mannekote Thippaiah, MD, FAP, FAM, Email: srinagesh_mannekote@dmgaz.org
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Abstract

It is challenging to treat symptoms of autism spectrum disorder (ASD), comorbid psychiatric disorders and ASD-associated symptoms. Some of the commonly used medications to treat these can, and frequently do have serious adverse side effects. Therefore, it is important to identify medications that are effective and with fewer side effects and negative outcomes. In this review, we looked at current evidence available for using the serotonin and norepinephrine reuptake inhibitors (SNRIs) class of medications in treating some of these often difficult to treat symptoms and behaviors. An extensive literature search was conducted using EBSCO.host. Our search algorithm identified 130 articles, 6 of which were deemed to meet criteria for the purpose of this review. Each of these six articles was independently reviewed and critically appraised. As a prototype of the SNRIs family, venlafaxine was found to be a useful adjuvant in children and adults with ASD for the treatment of self-injurious behaviors, aggression, and ADHD symptoms when used in doses lower than its antidepressant dosage. However, duloxetine was not found to show any added benefit in treatment of any of the comorbid symptoms and behaviors in ASD when compared to other antidepressants. On the other hand, milnacipran was reported to produce improvements in impulsivity, hyperactivity symptoms, and social functioning through reduction of inattention of ADHD when comorbid with ASD. Overall, SNRIs were shown variable effectiveness in treatment of these comorbid symptoms and behaviors in ASD.

Keywords

Autismautistic spectrum disorderpervasive developmental disorderSNRIsvenlafaxinedesvenlafaxineduloxetinemilnacipran
Type
Review
Information
CNS Spectrums , Volume 27 , Issue 3 , June 2022 , pp. 290 - 297
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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