Home > Science, Uncategorized > Propranolol for Behavior Challenges: Not Yet Ready for Widespread Use

Propranolol for Behavior Challenges: Not Yet Ready for Widespread Use

Posted by Autism Treatment Network Medical Director Dan Coury, MD 

Considerable community and scientific interest has been raised by recent reports that the beta-blocker propranolol improved word use in adolescents and adults with autism spectrum disorder (ASD). It is important to emphasize that this small study does not provide sufficient evidence of effectiveness or safety to support this use of the drug, which is FDA approved to treat high blood pressure. Although we share excitement in seeing medicines evaluated in bona fide clinical studies, families should be strongly cautioned against over-interpreting media reports as endorsement to pursue this treatment for their loved ones–until larger studies show it is safe and effective.

First and foremost, treatment of autism spectrum disorders (ASDs) should include a combination of behavioral and educational interventions. Many children, adolescents, and adults with ASDs also need treatment of associated medical or psychiatric conditions such as gastrointestinal disorders, asthma, anxiety, and symptoms of attention deficit and hyperactivity disorder (ADHD).

While we have strong evidence that our behavioral treatments provide benefit, we need more research on identifying medicines that can help relieve the core symptoms of ASDs and associated behavior challenges. Interest in propranolol began over 20 years ago, with a small study (involving eight adults with autism) that suggested the drug could reduce problematic aggression. In addition, the researchers noted subtle improvements in language and social behavior. They wondered whether this might be related to the known ability of beta-blockers to reduce the symptoms of so-called overarousal. For instance, some musicians and public speakers will take a beta-blocker immediately before a performance to reduce shakiness from stage anxiety.

The authors of that first study called for further research. And the gauntlet was picked up by David Beversdorf, MD, and his associates at the University of Missouri, one of Autism Speaks Autism Treatment Network (ATN) sites. Their latest report enrolled 14 high functioning teens and adults with autism, all of whom used spoken language. They found that, when taking the medicine, some of the individuals used more words over a given period of time. That is, they had greater “word fluency.” On average, the participants showed 25 percent greater word fluency. However, some of the participants spoke fewer words while taking the medication.

What does this mean? These early studies are too small and too limited in their evidence of benefit for us to recommend that adolescents and adults with ASD begin taking this medicine. We know even less about the safety and effectiveness of beta-blocker medications in younger children. As the authors state, further study is needed to confirm both safety and benefits among a wide range of persons with ASD. And if these benefits are confirmed, we need to find ways to identify which people will respond positively to the medication and which will not. Certainly this is not a medication we want to be administering to everyone on the autism spectrum.

These early studies encourage us to pursue further research with propranolol, as we are doing with an increasing number of other medicines that could potentially help relieve the core symptoms of autism–including repetitive behaviors and impaired communication and social behavior. This exciting and encouraging research includes our study of the biological effects and behavioral benefits of both already approved medications and newly developed compounds.

Meanwhile, we have two FDA-approved medications for treating autism-related irritability that includes aggressive behavior and tantrums. They are risperidone and aripiprazole, both of which influence brain levels of the biochemical serotonin. Newer studies are looking at alternative medicines that affect other brain pathways. Early animal research with these compounds has been promising, and studies are now underway in people.

Bottom line: Studies such as Dr. Beversdorf’s are helping us better understand brain function in persons with ASD. This and related studies will ultimately lead us to new treatments and better outcomes. Until then, please stay tuned.

  1. Sarah
    October 10, 2011 at 11:42 am

    Definetly a step in the right direction and we need more scientists to push the envelope like Dr. Beverdorf A 25% improvement in word fluency shows promise. Behavioral therapy helps to an extent but it is not enough. SSRI’s are not the answer either.

    I hope the research on propanolol will open the door for more research on suitable and effective drug treatments for autism. There has been a lot of research on underlying medical problems that may contribute to behaviors. I think a lot can be gleaned from studies on GI and brain inflammation and autism that has laid the groundwork for treatment.

    I would like to see more research on drugs that target whatever is causing inflammation in the GI and brain of children with autism. Also, damage to microglia and how that relates to behavior.

  2. Laurie
    October 10, 2011 at 11:47 am

    This is a fascinating study. I’d rather see persons taking Propranolol then Resperidone. I take it for High Blood Pressure and it definitely manages the fast heart beat and anxious feeling in a really subtle way.
    My agency just opened a residential treatment program for boys on the Autism Spectrum, and their coming in on anti-psychotics and ADHD drugs. I don’t find they are helping the anxiety, obessions and rumination.
    I think Cognitive Behavioral Therapy should be tried first, or in addition to meds, but I do see Propranolol’s benefit if it becomes approved. We have to be so careful with medicating our children. My own daughter suffers from severe anxiety and depression, and we’re now trying to get her off Depakote, Geodon, Klonpin, Topomax. People are too quick to treat with meds, in my humble opinion, and parents are so vulnerable when their children are suffering, they (we’ll) do anything.

  3. Tami
    October 10, 2011 at 12:47 pm

    In what way does a beta-blocker effect a person’s seratonin level?

  4. Marilyn Thompson
    October 10, 2011 at 2:38 pm

    I too would rather our daughter (21) take Propranolol than Resperidone. I will mention this
    to her dr this week at her appt, but, everytime I ask about something I read that I would like
    for her to try, he says NO. What can I do?

  5. Sarah
    October 10, 2011 at 3:17 pm

    Marilyn,

    Have you tried natural anti-inflammatories? FWIW, I do natural medicine with my son. He is on a natural anti-inflammatory called Lutimax whch targets inflammation in the brain. It contains a natural compound called Luteolin which is found in peppers, lemons and celery. He has had no adverse side effects. It helps him a lot. His teacher said he’s doing much better academically in school.

    here’s more info: http://lutimax.com/

    Even though the research breakthroughs are great, it takes a long time to reach and be accepted by the mainstream. I think many of us feel our kids are getting older and we simply can’t wait for the docs to figure it out.

  6. April
    October 10, 2011 at 3:57 pm

    Why hasnt this been delved into earlier? So we have stimulants, anti depressants and anti psychotics, but no beta blockers. Surely these are far less harmful than all the other medications? This really would be a great thing to encourage and see being sampled and used. I have heard of a few people whos children already have it and with great success.

    Surely this makes sense rather than the other ‘mind alterning chemicals’…..

  7. April
    October 10, 2011 at 3:59 pm

    Ps I understand it is for alleviation of ANXIETY thus decreasing aggression/hyperactivity….not to reduce depression in any form.

  8. Barbara r. Frankel, Ph.D..
    October 10, 2011 at 5:39 pm

    I have a young adult child with autism who has episodes of intense anxiety resulting in extreme tantrums and aggressive behavior. After resisting the antipsychotic medicines for years, I finally allowed him to take a course of Abilify and another with Seraquel. Neither worked to change his problematic behavior but they did change his personality by flattening his affect and generally taking away his most lovable parts. It was very disturbing but fortunately, temporary, in his case. Obviously, these medicines are much more harmful as they have potentially permanent side effects. If we are expected to experiment on our children with already existing drugs, I would much prefer a beta blocker than an antipsychotic or mood stabilizer. I am going to find a physician who will prescribe it to him — there’s no knowing how long we are expected to wait, given that it has already been in the research phase for 20 years!!

  9. Krista
    October 10, 2011 at 7:23 pm

    These medicines seem to be a good idea and when further information is found about the safety and effectiveness it will definately confirm my opinion. I do not however have an Autistic family member but I do know a few people at my school who are Autistic. And I’m sure it would help them if that is what their parents want. But overall these medicines without knowing if they’re safe or effective probably shouldn’t be used for that fact, just to be cautious.

  10. Katie Wright
    October 10, 2011 at 7:42 pm

    I have taken beta blockers prior to having to listen to interminable govt speeches on autism research. It lessened my desire to interrupt w questions or run out of the room in frustration. It is much safer than risperdone but I don’t think the effects are more than modest. Still worth trying.

  11. Sarah
    October 10, 2011 at 8:49 pm

    Then do a larger scale propanolol-autism study!!!! yes, we know about behavioral therapies, yada, yada yada.. most of our kids are getting behavioral therapy but that is not enough to reduce anxiety, hyperactivity and aggression!

    The orignal study on beta-blockers to treat autism was done in 1987. That was over 20 years ago!!! Our kids are growing up! They need help now! Lets not wait another 20!

    As far as FDA approved treatments, many of us do not want SSRI’s or anything that alters brain chemistry. I’m not a chemist but Beta blockers sound much safer than altering serotonin levels.

    The bottom line is the FDA and the medical community needs to move more quickly on clinical trials for beta blockers! Stop relying on old standby drugs.

    Here’s the original study:

    Open trial effects of beta-blockers on speech and social behaviors in 8 autistic adults. (1987)

    http://www.ncbi.nlm.nih.gov/pubmed/3654495

  12. Kathy Silverstein
    October 11, 2011 at 3:52 am

    Well, this is very interesting. I have Asperger’s, and I was once offered the choice of using beta blockers to try to control my anxiety. That took me by surprise at the time, because I never thought of beta blockers as a psychiatric drug, just one to treat physical disorders. But I have heard of other people using them that way. Now I hear that besides those benefits, they could also have benefits for other autism traits? I wonder if I should try it. I am currently taking Celexa. Maybe I will run it by my doctor sometime. I was on Abilify once. Worst 2 weeks of my life, let’s just say that. We need more options.
    Social skills an anxiety are both big issues in Asperger’s. I learned I am not the only one with this issue from this website I found the other night, http://www.aspergerssociety.org/articles/48.htm
    Thanks for the article. I hope it helps a lot of people.

  13. October 14, 2011 at 1:15 pm

    Whilst I agree that more studies are needed for large-scale recommendation of propranolol, individual test results on Autonomic Nervous System function in autism patients very often point to types of autonomic dysfunctions for which propranolol is the first treatment option.

    Likewise, propranolol is also one of the first choices for control of irritability and aggression, as well as for treatment of anxiety, including generalised and social anxiety, fear conditioning etc. (Abnormal fear conditioning has recently been correlated to severity of autism http://www.ncbi.nlm.nih.gov/pubmed/21905243 )

    Lastly, it is simply not true that not enough is known about its safety in children. It has been used on a large scale in young patients for cardiac problems and things like migraine prophylaxis and infantile haemangiomas (including in ‘preterm and very low weight infants’), with no significant side effects. Whilst there is no such thing as 100% safe medication, and monitoring for risks and signs of hypoglycaemia is one of the main recommendations, esp in very young and pre-term children, propranolol in general has a long history of safe and effective use in infants and children.

  14. old mom
    October 14, 2011 at 4:38 pm

    The notion of using propranolol as a behavioral intervention has been around for years. My son is an adult with autism and it did not help with behaviors. I have a few friends whose young adult children used it, but it didn’t help them, either. Unfortunately, we have had to resort to using anti-psychotics with limited success and horrible side effects. The propanolol didn’t really help much with tremors or pacing, either.
    I took propranolol for hypertension and it made me sleepy and my feet froze! I tend to have lots of anxiety and I can’t really say that it helped reduce that.
    Medications that help challenging behaviors don’t seem to come down the pipeline very often. ;-(

  15. John Scott Holman
    October 19, 2011 at 7:04 pm

    Beta blockers are very helpful when you need to combat anxiety. I have found anxiety to be the most frequent cause of my negative, autistic behavior.

    Risperidone is an anti-psychotic which caused me to experience horrendous dystonia which was without doubt the most unbearable physical sensation I have ever experienced. Other anti-psychotics have caused me to experience akathisia and dyskynesia.

    Benzodiazepines are effective in the treatment of panic, but are not generally considered to be of longterm benefit. Tolerance builds rapidly and dependency is debilitating.

    Beta blockers and anti-histamines are my chosen anxiety remedy, though very desperate times call for Ativan or Xanax.

  16. February 15, 2012 at 4:54 am

    i found this very helpful

  17. March 3, 2012 at 11:24 am

    I have struggled with panic attacks, anxiety and high BP for many years. Recently my doctor prescribed propranolol. It did not really help with the anxiety or blood pressure spikes I get when I am in trigger situations. Exercise helps me more than anything, as well as cognitive therapy and learning how to monitor and challenge my thought patterns. I have never heard of propranolol use for autism until I read this blog article, but if many of these disorders are related in some core way, it makes sense that it would have an effect. Hopefully as knowledge increases, more targeted strategies can be identified.

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