HansGruber wrote:As a neurologist, I have deep concerns about the over-prescription of Adderall and other amphetamines, especially to children. I understand that for many who have been diagnosed with ADD/ADHD, these drugs can be an effective treatment. But the long-term risks are not worth the short-term benefits.
Most neuroscientists are predicting a HUGE growth in the rate of neurodegenerative diseases such as Parkinsons, Alzheimers and ALS over the next 20 years, and we expect to see this trend in younger patients than in the past. We are especially concerned about the children who have been prescribed these drugs for ADD/ADHD, as long-term use of the drugs are known to accelerate the onset of these diseases and will begin manifesting symptoms fairly early for these patients, potentially as early as their 30's/40's.
There is strong evidence to support this theory, and one need look no further than the housewives who were prescribed amphetamines for depression and weight loss from the 1940's-1970's. Starting in the 1980's, we began to see a HUGE spike in Parkinsons and other NDDs among women shortly after menopause. A number of researchers began to study the trend, and discovered that many of these cases were women who had taken amphetamines earlier in life for an extended period of time - generally 2-5 years.
I won't go too much further into it, as much of the research on this topic is readily available online, and it is off-topic. I only mentioned this out of concern for SharkHawk and other posters who have said they use Adderall and it has been effective for them.
There are more effective non-amphetamine alternatives available on the market which do not pose anywhere near the same risk. And many of the symptoms patients experience when not taking these drugs are actually the result of amphetamine withdrawal, and should not be viewed as proof of the drug's efficacy. I beg each of you currently on these classes of drugs to find a quality psychiatrist who can speak with you about the alternatives and potentially find you a much safer medication without the addictive and dangerous side effects.
Sorry again for the temporary hi-jack... I'll shut up now.
I appreciate the info. As a neurologist I'm sure you see a lot. For me, it's a quality of life issue. Quite honestly if I hadn't been put on amphetamines in my mid-20's I am 100% certain I would have committed suicide or been permanently placed in a place for people who are a threat to themselves. So for me it's a quality of life issue. I had no quality of life from the time I was basically able to walk and talk and my mid-20's. If that means I end up with Parkinson's, then honestly it is worth the risk for me at this point. I wouldn't survive otherwise, and I did try every possible combination, therapy, etc. etc. before going the Ritalin then adderall route. If it was there my psychiatrist and I made a very serious decision and considered all consequences and attempted all options. It is never to be taken lightly and to me, it should be the last resort.
I have a 9 year old son who is as ADHD as I was at his age. We don't treat him with anything, except lots of love, tons of daily reminders and scheduling, and behavioral modification stuff we do as teachers (my wife and I are both certified teachers, and she has 16 years experience and a doctorate equivalent, so we have picked up a lot on educational psychology... probably as much as we can get without going to med school I'd guess). I'm not saying we're perfect, but we know the risks and for our son it is an absolute last resort, not a first or even second resort. The closest I've come to "drugging" him was to have him drink 4 oz. of Coca Cola when his brain is so scattered that he can't even put a sentence together and focus long enough to get his homework done. We do this rarely, and most of the time I or my wife act as his concentration center of his brain, which is precisely what I'd do for my students, by setting tiny goals, pointing at individual problem, creating milestones throughout the day, etc. I know the impact these medications have for sure. I just don't want to see them demonized for reasons like athletes using them or for recreational use. I also feel that as an adult I had to make the very serious decision of whether or not I wanted a life or wanted to continue with what I had. I took life and I'll live with the aftereffects. I can tell you for certain though that the difference was night and day. I know they are overprescribed, but I can absolutely and unequivocally guarantee you that I am one of the 1% of people who needs these medications in order to live. Honestly. I derive no enjoyment from taking them. I don't take them on weekends or holidays, workdays only. I don't get a "high", and I take the smallest dosage possible.
Sorry to off-track myself there... just felt it was worth responding to, and I didn't take my adderall today because I have been sick.
I'm sorry, I wouldn't normally do this, and it's definitely not the purpose of this thread, but as a psychiatrist, I think the blanket generalizations you have made about prescription stimulants are misleading. I do not claim to be an expert in dementia, but my particular area of focus going forward is neuropsychiatry, and this is a particularly hot topic. You're a neurologist so I won't patronize you by claiming to know more about this topic, but I do feel I have some ground to speak. Correlational studies, particularly retrospective studies, do not prove this point. Current prescription stimulants, specifically ritalin and its successors, did not begin being prescribed for ADD/ADHD until the mid-60s. Its use prior to that is difficult to study for a variety of reasons, not the least of which is the difficulty in obtaining medical records from 30 years ago (if these studies are conducted in the 1980s). These sorts of studies are prone to all sorts of bias, most specifically recall bias, but we don't need to get into that here. The effects of prescription stimulants are, of course, different from street-made methamphetamine, which has its own slew of issues.
Long-term use of these drugs is not 'known' to accelerate the onset of Alzheimer's, certainly not in the majority of patients who take these medications. I have not seen any convincing, rigorously-designed studies that suggest this. If you have them, I would love to see them, and please feel free to PM me their citations. I'm perfectly happy to learn something new about my profession, but as you are aware, stimulants are widely prescribed, and neurodegenerative disorders are an extremely hot issue right now, and therefore I find it difficult to believe the research is as convincing as you say if it is not more widely disseminated among prescribers.
That said, what I really disagree with is the following:
Your description of the benefits as 'short-term.' SharkHawk, I believe, made a very nice point. ADHD is not about short-term benefits, as it can severely impact the intellectual and social growth and development of a child. It impacts grades, college applications, job applications, and life trajectory. ADHD is NOT a disease that individuals grow out of reliably, contrary to popular belief, and up to 2/3 of children diagnosed in grades 1-4 with ADHD persist with symptoms into adulthood. Amphetamines can have known cardiovascular and abuse-related risks which are clearly concerning, but the distinction between risk and benefit is not that clean-cut.
Your assertion that there are "more effective" non-amphetamine alternatives available which do not pose anywhere near the same risk. This may be a bit ticky-tack, but I want to clarify that these non-amphetamine alternatives, such as atomoxetine, modafinil (off-label), buproprion, etc, are NOT more effective on an individual basis. Atomoxetine is the most promising of these, and probably is approximately as likely (percentagewise) to relieve symptoms when prescribed, de novo, to children between grades 1-4 for the treatment of ADHD. It is not the case that you can substitute mixed amphetamine salts for atomoxetine in long-term patients and expect continued symptom remission. Moreover, as many of them are (relatively) new, particularly atomoxetine which is still under patent, their long-term side effect profile is more opaque. That does not NECESSARILY mean that they are 'far safer,' particularly for individuals with seizure disorders or other medical comorbidities.
Amphetamine salts, such as ritalin, adderall, concerta, focalin, and others remain, and will continue to remain a valuable tool for ADHD. It is not the first medication I would prescribe for ADHD, and I think that over time amphetamine salts will be relegated to second-line status for ADHD in children who fail a trial of strattera (atomoxetine). I think behavioral interventions, just as SharkHawk suggested, can be very effective as well, and obviously this decision should be made carefully with each patient, parent, and child.