Delivering medicines in psychiatry the transdermal way: application to autism

The real iron man

Pharmaceutical technology, and specifically the various research strategies looking at the way that medicines are delivered to the body, is probably not a topic high on most people's list of interests. This area is generally not 'sexy' research insofar as producing headlines about almost miracle interventions for condition X or label Y. Instead, we take for granted that the tablet or capsule we have been given has been formulated and tested or that the nicotine patch that you may be wearing includes some pretty comprehensive physics, chemistry and biology behind its development.

In order to raise the profile - even champion the role - of pharmaceutical technology, I'm briefly bringing the paper from Jonathan Stevens and colleagues [1] to your attention, reviewing the literature "related to transdermal delivery systems from the perspective of clinical practice and research related to their use in the treatment of psychiatric conditions." Transdermal delivery by the way, refers to the various ways and means that medicines can be formulated to pass through the skin and into general circulation. This method has significant advantages insofar as bypassing the gastrointestinal (GI) tract and the first pass effect among other things. This might also be important from the point of view of those trillions of wee beasties that call our gut home [2].

I've covered some of the ways and means that transdermal drug delivery might impact / has impacted on conditions like autism before on this blog. This has included the very preliminary suggestion that transdermal nicotine patches might impact on individual cases of aggression comorbid to autism (see here) and some of my own research (see here) looking into the now controversial suggestion that dermal preparations of low dose naltrexone might be useful for various conditions [3].

Insofar as some of the other research talking about transdermal preparations and autism, there are a few studies to quickly direct you towards. The trial by Kern and colleagues [4] is worth mentioning in view of their use of transdermal glutathione with autism in mind and effects "improving some of the transsulfuration metabolites." Glutathione is something of an elephant in the room when it comes to at least some cases of autism (see here). There is also the older study by Fankhauser et al [5] to consider, describing the use of transdermal clonidine in cases of autism. I'm not necessarily advocating clonidine for autism (despite there being some indications for some use) but what this research does suggest is that various medicines currently used to manage some core and peripheral aspects of autism are perhaps ripe for re-formulation in order to better control drug delivery and potentially increase important issues such as compliance to specific medication  regimes. Dare I also mention the use of transdermal secretin [6] when it comes to autism too?

I do think we are going to see more and more about transdermal drug delivery systems being used when it comes to autism and beyond in future times. Coupled to other drug delivery methods such as via the nasal route (think oxytocin and autism... carefully) and the days of pill-popping and even painful injections (all hail micro-needles) may well be numbered.

Music: The Cure - Boys Don't Cry. Well, only at the football (soccer) match and/or when watching Watership Down.

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[1] Stevens JR. et al. The Use of Transdermal Therapeutic Systems in Psychiatric Care: A Primer on Patches. Psychosomatics. 2015 Apr 1. pii: S0033-3182(15)00060-2.

[2] Swanson HI. Drug Metabolism by the Host and Gut Microbiota: A Partnership or Rivalry? Drug Metab Dispos. 2015 Aug 10. pii: dmd.115.065714.

[3] Bouvard MP. et al. Low-dose naltrexone effects on plasma chemistries and clinical symptoms in autism: a double-blind, placebo-controlled study. Psychiatry Res. 1995 Oct 16;58(3):191-201.

[4] Kern JK. et al. A clinical trial of glutathione supplementation in autism spectrum disorders. Med Sci Monit. 2011 Dec;17(12):CR677-82.

[5] Fankhauser MP. et al. A double-blind, placebo-controlled study of the efficacy of transdermal clonidine in autism. J Clin Psychiatry. 1992 Mar;53(3):77-82.

[6] Ratliff-Schaub K. et al. Randomized controlled trial of transdermal secretin on behavior of children with autism. Autism. 2005 Jul;9(3):256-65.

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Stevens, J., Justin Coffey, M., Fojtik, M., Kurtz, K., & Stern, T. (2015). The Use of Transdermal Therapeutic Systems in Psychiatric Care: A Primer on Patches Psychosomatics DOI: 10.1016/j.psym.2015.03.007