Sunday, April 5, 2009

ADD medication or amphetamine--a hit of speed is a hit of speed by any other name

This from Psychiatric Times (thanks to Gianna for the quote):

"Medications used to treat ADHD in children may lead to psychotic symptoms and hallucinations, according to Dr Andrew Mosholder of the US Food and Drug Administration and colleagues.

"The researchers looked at 49 randomized, controlled clinical trials in the pediatric development programs for ADHD products and found evidence of psychosis or mania linked with almost every one of the eight ADHD medications/compounds studied (including extended release variations, tablets and transdermal patches). Although there were no reports of such reactions in patients on placebo, the overall rate was 1.48 events per 100 person-years for those on the ADHD medications.

"In data from manufacturer postmarketing studies, the researchers found 865 unique reports describing symptoms of psychosis or mania; the majority of the cases were pediatric and nearly half were children age 10 years old or younger. Symptom resolution resulted in 25% to 59% of cases after medication discontinuation."

And theLA Times reports

"Just under 8% of U.S. children, ages 4 to 17, have been diagnosed with ADHD, according to a survey conducted in 2003 by the Centers for Disease Control and Prevention. More than half of these children were taking a medication for the disorder. However, the research reported today shows that psychotic symptoms occurred even in children who were not considered at high risk for psychosis or mania, such as children who abuse drugs or have other mental illnesses. In more than 90% of the cases, the children had never experienced hallucinations or psychosis. In most cases, the hallucinations were visual and tactile and involved seeing or feeling bugs, worms or snakes. The symptoms typically disappeared after the children stopped taking ADHD medication."

"It's not clear just why some children experience psychotic reactions to the drugs or what causes the symptoms. However, doctors should explain to parents that any psychosis or mania that occurs during treatment could be from the drug itself, said the authors of the report. And, they add, their paper is fresh evidence regarding the limitations of short-term clinical trials. The clinical trials of stimulant drugs showed a much lower rate of psychotic symptoms, but it wasn't until the medications were widely prescribed in a broad range of people that psychotic adverse events became prominent."

Now, why is this such a surprise? Why does the last paragraph have the researchers putting on their best baffled face? We've all been aware of the fact that uppers like cocaine, amphetamine, and meth can induce temporary psychosis in their users for years. In fact, the psychiatrists themselves have an entry in their DSM-IV for drug induced psychosis. Why is it that when the label on the pill bottle says Adderal, when it's prescribed rather than bought on the street, when a difference in learning styles labeled ADD by an American Psychiatric Association committee offers Big Pharma an opportunity to cash in that we see the amphetamine pills in the bottle as somehow benign?

The artificial conceptual division between licit and illicit mind altering drugs does us harm, crippling our common sense. We KNOW how illicit drugs work. In fact, the scare tactics of the drug war have been letting us know about exaggerated accounts of their risks for years. And the harm reduction movement has taught us how to take those risks into account and deal with them. But when the psychotropic drug is psychiatrist prescribed, we tend to treat them as if they're as harmless as candy, and our natural skepticism disappears. It takes journalistic exposes to tell us that Zyprexa causes adult onset diabetes and that Prozac causes suicidality and homocidality in some, even though their makers knew about these ill effects for years. It takes medical journals years to admit that psychiatric drugs make for horrific withdrawals, even when some of the withdrawal effects rival the most atrocious cold turkeys that illegal drugs can provide--Paxil, with its subjective experience of electric shocks to the brain, its aches and pains, its weeks of hysteria, had makers jumping through hoops to deny these effects until finally too many people experienced them

So especially when the illicit drug and the psychiatric drug are the *same* substance--and don't talk to me about meth, because in Europe amphetamine sulfate--yes, Adderal--is the upper of choice, a hugely popular club and lifestyle drug--we need to look past the packaging and the social context and apply what we know about the drug as a recreational substance to its effects as a psychiatric "medication".

And, in the Washington Times, on 3/27/09:

"One principal scientist in the study, psychologist William Pelham, said that the most obvious interpretation of the [longterm] data is that the medications are useful in the short term but ineffective over longer periods.... [Let's not even go into what this article has to say about what this man's colleagues are doing to obfuscate or try to explain away the damninng results of the study]

"...The MTA [the study] was designed to test whether children diagnosed with attention-deficit hyperactivity disorder, or ADHD, do better when treated with drugs, with drugs plus talk therapy, with talk therapy alone or with routine medical care alone. Children with the disorder have trouble paying attention, are restless and hyperactive, and are sometimes disruptive in school.

"The initial 14-month analysis published in 1999 randomly assigned children to one of four treatment options and showed clearly that those treated with medication did much better than those who got only talk therapy or routine care. The drugs' manufacturers distributed thousands of reprints of the article to physicians at a time when diagnoses of ADHD were spiraling upward. Because children given drugs alone appeared to do about as well as those treated with both drugs and talk therapy, the study skewed treatment in the direction of medication...

"In August 2007, the MTA researchers reported the first follow-up data, which by then no longer showed differences in behavior between children who were medicated and those who were not. But the data did show that children who took the drugs for 36 months were about an inch shorter and six pounds lighter than those who did not.

Now, again, anyone who has taken speed to study, from the first university students in the 50s who sniffed benzedrine inhalers before their midterms, could've told you all this. Speed works at first for what the psychiatric industry labels ADD because it improves short term concentration (and don't talk to me about paradoxical effects, with speed making "normal" people hyperactive and those with ADD calm--it calms *everyone* in a way because it temporarily improves focus.) But the mind cannot sustain this artificially honed concentration for long, and soon enough speed leads one into tangents or mindless rote behavior which makes study and focus just as difficult as ever. Over long term use, the strain on the body becomes quite a problem. These researchers should have known intuitively what it took a study with suffering, young human subjects for them to discover--that children would suffer the worst from that strain because their bodies were not yet fully developed. Stunted growth, to the extent of being an inch shorter and six pounds lighter? I bet these kids would have preferred the extra trouble of organically learning to deal with their difficulties in paying attention in classes that utilized traditional learning formats to the ruin that years of amphetamine they had no choice but to take wreaked on their bodies. If it were not given the lofty name of research, forcing children to take amphetamines would probably have NIDA and other drug war organizations up in arms--thankfully, they save their ire for people of color in the black market attempting to support their families rather than white, respectable research doctors with fancy degrees.

To see how the researchers have "bent over backwards", in the words of one of the more honest among them, to explain away the results of this study so no harm is done to Big Pharma's reputation, here's the original Washington Post article I was quoting from.


  1. Well, you and I are going to disagree on this, but I think that although there clearly are considerable negative side effects from ADHD meds, many kids have been helped by them in terms of improving academic and social functioning. I've seen kids placed in classroom for the mentally retarded because their ADHD was so incapacitating and when the appropriate meds were found, the kids were able to do well in regular classrooms. I've seen it go the other way as well. The decision is always whether or not the drawbacks outweigh the benefits.

  2. Sure it can help. Speed helps a lot of college students study at first too. But just as the college students could prob. use a better study method and more time and patience from their instructors, so could these younger kids. Read the articles. No longterm efficacy and stunted growth? Doesn't sound like the risks outweigh the benefits to me. And I think forcing someone to take a drug as intensely mind altering as speed is literally torturous.

  3. Yeah, there are probably other techniques that can help kids to some extent, but first of all those are pretty implausible in inner cities- no one has the $$$ or time for cognitive-behavioral retraining.

    Also, I will still say that there are some cases that will be near impossible to address without medication, at least initially. I'm not drinking the kool-aid, I have worked with these kids myself, children who literally fail IQ tests because they can't attend long enough to hear the questions. Kids whose impulsivity prevents them from even being in a normal therapy situation because they will do the first thing that comes to mind- slap the other person, run out of the room, etc.

  4. Well, in these extreme situations you're discussing, the parents should be told exactly what the kids are taking, and the speed should only be taken long enough for the kid to get better coping mechanisms into place. Like I said, and like the studies bear out, it's only a short term solution anyway. But I think the extreme situations you cite are just that, and most kids could get by w/o being force dosed with uppers.
    & in terms of underfunded inner city schools, what we need to do there--what FC is starting to do--is to attempt to create networks of sliding scale or free homeopathic etc. providers. Acupuncture can help focus, so can a number of herbs. Eliminating sugar etc from a child's diet can decrease hyperactivity. Also, in a lot of these inner city situations, the violence you're describing is not biochemical in origin, I don't think--it's kids responding to trauma either from family of origin or the situation of poverty they're in or the social milieu--schools should give kids space to talk to a trusted person around that, maybe create peer support groups facilitated by an adult the kids feel comfortable with...Giving kids something as dangerous and volatile as speed b/c we're just underfunded is just not enough of an excuse.