Showing posts with label Cyproheptadine. Show all posts
Showing posts with label Cyproheptadine. Show all posts

Monday 23 September 2013

Autism Biomarkers – Serotonin: LSD, SSRIs & Cyproheptadine/Periatin

Researchers are always looking for biomarkers of autism as a diagnostic tool; I am more interested in biomarkers as an indicator of might be going wrong and hence, perhaps, an indicator of what to do about it.

Going back more than half a century, just such a biomarker was found.  Increased platelet levels of 5-HT (5-Hydroxytryptophan) were found in 30-40% of the autistic population.  5-HTP increases the production of the neurotransmitter serotonin and so it was suggested that hyperserotonemia may be a factor in autism.

Hyperseratonemia (Serotonin syndrome)

Hyperseratonemia is not treated by reducing the amount of serotonin, rather by using a receptor antagonist that in effect blocks the serotonin effect.

SSRIs and other anti-depressants

Several classes of drugs target the 5-HT system including  anti-depressants, antipsychotics, anxiolytics, antiemetics, and antimigraine drugs, as well as the psychedelic drugs and empathogens.

In you live in the US, you will have heard of Prozac (vitamin P) which is a very widely prescribed anti-depressant.  It is in a class of drug called Selective Serotonin Re-uptake Inhibitors or SSRI.  Many autistic children in the US are prescribed SSRIs like Prozac. In Japan Prozac is illegal.

SSRIs are believed to increase the extracellular level of serotoinin by inhibiting its reuptake.  Excessive use of SSRIs is known to lead to hyperseratonemia.  If you are already prone to hyperserotonemia, like 40% of autistic kids, it would seem that SSRIs could be potentially dangerous drugs.

A good deal of research does exist on the use of SSRIs in autism and it pretty much shows that they do not do much good, (and they certainly can have nasty side effects).  Look at page 6, in the review paper below that included all kinds of drugs trialled in autism.

LSD and other serotonin antagonists

LSD is a banned substance in the US and Europe, but in the time before I was born, it was being used to treat autism.  LSD, among other things, is a serotonin antagonist.  There are indeed several papers published on its use in autism and other conditions.

I was quite surprised to see Ivaar Lovaas, the “father” of Applied Behavioural Analysis (ABA) was merrily giving autistic children LSD at UCLA in the early 1960s.

These old studies are quite interesting and if you want more just click here.

I am not suggesting you take your child to Amsterdam, but if you look on Google you will see that adults with ASD are indeed using LSD therapy.

It now appears that after being banned from use decades ago, medical research with LSD has been restarted.

Fortunately, there are other serotonin antagonists that are available and will not land you in trouble.  The one that attracted my attention is Cyproheptadine or Periactin.

Cyproheptadine in Research

There has been just one study published on autism and Cyproheptadine and that was in 2004.  It is not exactly what we need, since it was being trialed as an adjunct therapy to haloperidol.  Haloperidol is an antipsychotic.

If you live in the US you will be familiar with Risperidone, which is another antipsychotic shown to be effective in autism. In the UK, only specialists such as child psychiatrists can prescribe risperidone for children with autism.  Risperidone can cause side effects like uncontrollable shaking.

So the trial was in effect to see the effect of the antipsychotic + Cyproheptadine vs antipsychotic + placebo.  This is not exactly what we want, but better than nothing.

As you will see in the charts below, the addition of Cyproheptadine did indeed make a marked improvement.  Sadly this research has not been followed up on.


Serotonin and Emotional Response

There was a recent study looking at how the emotional response of adults with autism was affected by lowering serotonin levels, I could not find the full version.


Elevated blood levels of serotonin may or may not be a “red herring” in autism research.  The evidence is far from complete and it is not going to be a magic bullet.  Nonetheless, I suspect lowering serotonin levels may have far more impact than those expensive high EPA Omega 3 pills many parents are feeding to their kids.

The latest research does actually indicate that genetic differences cause the high levels of 5-HT in autism.  100% conclusive research does not exist showing the value of counteracting this genetic difference.  A safe, cheap, serotonin antagonist, Cyproheptadine /Periactin does exist; and it is available OTC in some countries.

Autism gene variant causes hyperserotonemia, serotonin receptor hypersensitivity, social impairment and repetitive behavior