Asperger’s, Serotonin, OCD, and Treatment

Reader’s Question

I recently found that I have mostly likely been dealing with the effects of Asperger’s Syndrome for the last 20 years or so. Not knowing exactly what it was until within the last year, I have learned to adapt to and deal with most of the negative side effects. While I have for the most part worked it all out for myself, I still suffer from the social deficits. I have never been able to practice the social skillsets needed to enjoy regular friendships or initiate intimate relationships on my own. The depression and OCD ticks that accompany being isolated and thinking I’m just “weird” for so long get in the way now that I understand where they come from. I hardly notice them when I am not under duress, and in fact find some of the OCD traits quite helpful in my work. Of course, practicing social (and intimate) skills can be quite stressful. Because in my case neither are chronic conditions I have always been very wary of using anti-depressants or anti-anxiolitics as my experience has been that acquaintances receiving treatment are on these long term, and that counselors and physicians I have sought help from in the past also saw them as a long term solution. They are certainly not the solution to my problem, but I need a way to fend them off while I fix the underlying issues: Are there short term, or more immediate options? I’m tired of feeling lonely and isolated now that I know what I need to fix.

Psychologist’s Reply

Symptoms of depression and Obsessive-Compulsive Disorder (OCD) are well recognized to be related to the brain’s serotonergic (5-HT) system. In the extensive research, decreased availability of Serotonin produces a variety of mental health symptoms, prompting the development of antidepressant medications that increase Serotonin availability — the famous Selective Serotonin Reuptake Inhibitors (SSRI’s). Research has also linked low Serotonin with what we call the “negative symptoms” of schizophrenia. These symptoms are social and emotional in nature such as lack of social interest, inability to experience pleasure, difficulty in social interactions, impaired emotional reciprocity, difficulty with emotional expression, etc. Many of our modern antipsychotic medications appear to improve these negative symptoms by targeting Serotonin.

Research is supporting a link between Asperger’s Disorder and the serotonergic system as well. An article in the American Journal of Psychiatry (May 2006) by Murphy et. al entitled “Cortical Serotonin 5-HT2a Receptor Binding and Social Communication in Adults with Asperger’s Syndrome: An in Vivo SPECT Study” found a significant reduction in Serotonin availability in Asperger’s and offered, “reduced receptor binding was significantly related to abnormal social communication”. In plain English, low levels of Serotonin and/or Serotonin “responsivity” seem directly linked to the multiple social interaction and communications difficulties found in Asperger’s Disorder. This same link is also supported in “negative symptoms”, depression, and other psychiatric issues (OCD, eating disorders, body dysmorphic disorders, etc.).

While you mention that your OCD and depression symptoms are not chronic problems, in truth they are chronic problems. They are always present in your social and emotional interaction — they just become worse under stress. Even when the symptoms are operating at a low level, they impair your ability to experience pleasure, relate joyfully with others, and normally interact/communicate. As you mention, over the years you have adapted to the situation, accepting a certain level of symptoms as your normal day. We don’t want to view feeling lonely and isolated as a normal day. What can you do? I’d recommend two approaches. I would first consider medication to address the cluster of symptoms (depression, OCD, Asperger’s features) that are related to low Serotonin availability. If you don’t address this foundation issue, you will be less likely to benefit from any short-term or cognitive treatment options. An antidepressant may improve your receptiveness to cognitive-behavioral therapy and social skills building approaches for example. I’d also look for Asperger’s websites that often offer social skill tips and recommendations. Individual counseling/therapy should also be considered. Individuals with Asperger’s can often benefit from the clinical feedback provided in a therapeutic setting. Asperger’s is strongly linked to the neurotransmitter systems and brain locations that are important in social interaction and emotional response. Address that foundation issue, then, with professional guidance, select specific individual and group treatments that target your individual areas of concern.

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