Day 40 of 99 Days to FASDay: Psychotropic Medication Algorithm for FASD

In 2017 when the first 99 Day Journey began, I discovered an article called Team to develop the first medication guidelines for FASD at the University of Saskatchewan (Canada).

The idea is to examine the various complications that people with FASD face, such as inattention, difficulty planning, challenges in relational situations, and issues with mood and sleeping.

Then, the group will recommend medical guidelines instructing doctors what to prescribe “so that when a physician says to his patient, ‘I need you to take this medicine,’ they’re going to be doing it from an informed position,” Dr. Mansfield Mela, head of the psycholegal and FASD research lab at the U of S, told CBC Radio’s Saskatoon Morning.

In 2019 I contacted the University to see if there was a follow-up or a report of results or next steps as it sounds promising. And while the only response I got was that my enquiry had been sent to the research team, I did belong to a group that was asked to test the initial algorithm.

I gave a copy of the algorithm to the maiden’s psychiatrist at the time, but she didn’t seem interested. So once again, professionals fail to take the lived experience of patients with FASD and their caregivers. It’s disheartening to say the least.


Psychotropic Medication Algorithm released in 2020


According to an article from CanFASD :

Dr. Mela and a team of 12 multidisciplinary international experts (see list below) have spent over 2 years developing a decision-tree style medication algorithm to guide prescribers as they see patients with Fetal Alcohol Spectrum Disorder / Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (FASD/ND-PAE).

This algorithm is the first-ever treatment recommendation for psychotropic medications for FASD/ND-PAE. It is based on all available evidence (albeit very limited), which was consolidated in a recently published systematic review (Mela M, Okpalauwaekwe U, Anderson T, Eng J, Nomani S, Ahmed A, Barr AM. The utility of psychotropic drugs on patients with Fetal Alcohol Spectrum Disorder (FASD): a systematic review. Psychiatry and Clinical Psychopharmacology. 2018:1-10). 

From there, the algorithm was developed by considering the evidence and incorporating the clinical perspective of the expert panel.

Now that the algorithm is developed, it needs to be evaluated to understand the effectiveness and allow for improvements for future iterations.

This medication algorithm is intended for individuals with a primary diagnosis of:

  • Neurodevelopmental Disorder associated with Prenatal Alcohol Exposure
  • Fetal Alcohol Syndrome Disorder (with or without sentinel facial features)
  • Alcohol-related Neurodevelopmental Disorder

As a clinician, it is important to identify the primary “clusters” (domains) to target treatment. The first line of treatment is reserved for the cluster with the most impairing effect on functioning.

After an adequate trial of the medications from the first line, medications from the second line can be tried, followed by other traditional guidance.

Finally, if the first or second line medications are not effective, the adjunct treatment may be considered from the list in the algorithm.

The clusters include:

  • Hyper-arousal (with hypervigilance, aggression, insomnia, irritability, agitation, anger, anxiety, tension, reduced pain threshold)
  • Emotional dysregulation (with mood swings, excitability, anxiety, depression)
  • Hyperactivity/Neurocognitive (with restless movements, impulsiveness, inattention, distractibility and executive dysfunction)
  • Cognitive inflexibility with impaired perspective taking, poor abstraction, low frustration tolerance, poor social skills and impaired reasoning and reality testing

PDF copy: Psychotropic-Medication-Algorithm-for-FASD (1)

Jeff Noble interviewed Dr. Mela in April 2020 for a webinar about the algorithm. If you’d like to be involved in the research, you can share the Algorithm with your health care provider and ask them to fill out a short survey. Check out the replay: Dr. Mela FASD Medication Algorithm Webinar

Psychotropic Medication Algorithm Panel of Experts

Mansfield Mela
University of Saskatchewan, College of Medicine, Department of Psychiatry, Canada

Ana Hanlon-Dearman
University of Manitoba, Faculty of Medicine, Pediatrics and Child Health, Canada

AG Ahmed
Royal Ottawa Hospital, Canada

Susan D. Rich
Child Psychiatrist and Founder, 7th Generation Foundation, Inc, US

Rod Densmore
Urban Aboriginal Health Centre, Interior Health, Kamloops, B.C, Canada

Dorothy Reid
CanFASD Research Network

Alasdair Barr
University of British Columbia, Department of Pharmacology, Canada

David Osser
Harvard Medical School, US

Tara Anderson
University of Saskatchewan, College of Medicine, Department of Psychiatry, Canada

Bola Suberu
Private practice and Staff Psychiatrist, Medicine Hat Regional Hospital, Canada

Osman Ipsiroglu
University of British Columbia, Faculty of Medicine, Department of Pediatrics, Canada

Hasu Rajani
University of Alberta, Faculty of Medicine & Dentistry, Division of General and Community Pediatrics, Canada

Christine Loock
University of British Columbia, Faculty of Medicine, Department of Pediatrics, Canada


Please note I am not a medical professional. I am sharing my journey and providing links to information I feel is from credible sources. ALWAYS seek out professional guidance.

Check back tomorrow as we shift gears on our 99 day journey.

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