Prenatal alcohol exposure can interfere with neurotransmitter production, reception, and cellular calcium ion function in the brain. This results in varying deficiencies in multiple neurotransmitter systems among individuals with fetal alcohol spectrum disorder (FASD). As a consequence, people with FASD often respond differently to psychotropic medications aimed at restoring neurotransmitter levels, since the medications may affect deficient neurotransmitter systems in different ways depending on the individual. Doctors should understand how FASD impacts neurotransmitter functioning in order to properly assess patients and prescribe psychotropic medications tailored to their specific needs.

1. Why do those with fasd react to medications so differently?
Up to now, psychotropic medications act on neurotransmitters.
They may act in different ways but the aim is to restore the levels of the
neurotransmitter to what is considered to be its normal level.
Wikipedia. “Neurotransmitters are endogenous chemicals that
enable neurotransmission. It is a type of chemical messenger
which transmits signals across a chemical synapse, such as
a neuromuscular junction, from one neuron (nerve cell) to
another "target" neuron, muscle cell, or gland
cell.[1] Neurotransmitters are released from synaptic vesicles in
synapses into the synaptic cleft, where they are received
by neurotransmitter receptors on the target cells.”
Prenatal alcohol may interfere with all these steps of neurotransmitter
production and reception.
An important result of pae is interference with cellular calcium ion
function, which will contribute to the problem.
Since those with FASD can have these multiple neurotransmitter
deficiencies to varying degrees it is inevitable that they will have
varying responses to psychotropic medications.
This is why those who prescribe psychotropic medications should have
an understanding of fasd, and assess their patients accordingly before
prescribing them.
Focus On: Neurotransmitter Systems
C. Fernando Valenzuela, M.D., Ph.D., Michael P. Puglia, and Stefano
Zucca, M.Sc.

2. Alcohol Res Health. 2011; 34(1): 106–120. PMCID:
PMC3860557
PMID: 23580048
Fetal Alcohol Spectrum Disorders: Experimental Treatments and
Strategies for Intervention
Nirelia M. Idrus, Ph.D. and Jennifer D. Thomas, Ph.D.
Alcohol Res Health. 2011; 34(1): 76–85.
PMCID: PMC3831616: PMID 23580044 NIHMSID: NIHMS500036