Memantine

That can't do.

Even though there's a few FDA approved, as a doctor who's prescribed them for many patients back before I knew better, literally I've never had a single patient come back and say, man, that air set, that Naminda grandpa is like a new man.

Exactly zero times did I ever get that from a patient.

The best I ever heard was, I

But really what we have are drugs that really treat symptoms and treat the progression or slow the progression.

So when you're talking about symptom management, you may have heard of drugs like Namenda or Aricept.

We even have drugs for behavior or psychological changes.

But the two real kind of game changers in the last several years are these drugs that slow progression.

So it's equivalent to if you have a headache, take Tylenol, right, or acetaminophen.

Those are medications that we've had, you know, Denepazil or Ariceb, Memantine or Namenda.

These are medications that we've been given for the past 20 years.

But we really had no way.

As with all pharma companies, you know, Allergan had a focus on life cycle management, and it's really about squeezing every last drop of value out of the assets that are already approved.

The Brent Saunders version of that, uh, I think a good example of that is what he did at Forest Labs with an Alzheimer's drugs called Namenda, which was taken twice a day.

It was about to lose patent protection, so they made a new patented version, so-called Namenda XR, that only had to be taken once a day.

So this is a very normal occurrence in the pharma industry, and normally a company just heavily starts to market the new drug to convince physicians to swap over.

That campaign usually starts right near the end of the exclusivity period of the original drug.

They may also give you something called an NMDA inhibitor.

NMDA is another neurotransmitter, so-called Namenda.

And they may even give you an antibody against amyloid, which I'm not a fan of, either Lekembe or Kisulna.

And I'm not a fan because of the side effects up to a third of patients get brain bleeds and brain swelling.

Okay, so how does Aricept or Dinepazil work? It increases the amount of acetylcholine.

And unfortunately, you can see side effects like nausea, weakness, cramps, and insomnia.

But what Aricept and Namenda can do is they can slow down the decline, but you normally don't see reversal.

So what are examples of So that's a medication that increases acetylcholine, but we also have to be concerned about what medications and supplements our patients are taking.

None of these choices are a miracle.

Memantine study was short and modest in size, so larger and longer tests are still needed.

Not every person will respond, and any new medicine should be started only with a doctor who knows both conditions well.

Still, a growing list of options matters.

Today, we're looking at a 2025 double-blind randomized control trial.

This paper, titled Memantine to Treat Social Impairment in Youths with Autism Spectrum Disorder, a Randomized Control Trial by Joshi et al.

This study is an important step in understanding autism through a neurobiological lens, moving us beyond the idea of autism as a single uniform condition.

We know that social communication difficulties remain one of the most functionally disabling aspects of autism.

what's known as the excitatory inhibitory imbalance or EI imbalance.

This can lead to excessive or poorly regulated glutamatergic activity.

Memantine acts as a moderate affinity, non-competitive NMDA receptor antagonist.

This is different from ketamine.

And memantine specifically tackles that drowning houseplant issue, doesn't it?

It does.

Memantine is classified as a non-competitive NMDA antagonist.

It physically binds to those NMDA receptor channels and acts as a blockade.

Just