Weighing The Risk Of ADHD Meds

Dr. William Fisher is a psychiatrist at Columbia University Medical Center in New York City.
It's easy to see from this segment what a controversial issue the use of stimulant medication both prescribed and "unofficial" is. So what do we know for sure? One thing we know is that there is a compelling evidence base that supports the ability of stimulant medications to treat the core symptoms of Attention Deficit Hyperactivity Disorder in children. We also know that prescription stimulants are in widespread use among high school and college students without prescriptions.

Why is this? What follows is speculation on my part; this is a phenomenon that could use more study.

There's a lot of Adderall (and its cousins) out there. ADHD is being more widely diagnosed in children and carries less stigma than it used to. In addition, we have a better understanding now that a substantial portion of childhood ADHD persists into adolescence and adulthood. Physicians (both psychiatrists and non-psychiatrists) turn to stimulant medications because they provide effective symptom control. But a number of these kids could probably be effectively treated with behavior therapy, although it is much more time consuming for the child, the parents and the physician or therapist.

ADHD may also be over-diagnosed. This is probably particularly true when the person first seeks help as an adolescent because then a childhood history of symptoms (required for a diagnosis of ADHD) has to be obtained by recall rather than the direct observations of parents and teachers (which is the way the diagnosis is made in childhood). In addition, some adolescents who don't have ADHD but want a stimulant as a study aid or recreational drug know what kind of history and symptoms to describe to lead the physician to an ADHD diagnosis and a stimulant prescription. (Physicians are no better "lie detectors" than anyone else.) But I think the more usual route is borrowing or buying the stimulant from someone to whom it was prescribed. Even then, why do these people have leftover medication to sell or give away? Probably either because they don't have ADHD (misdiagnosis) and are using their stimulant as an occasional study or recreational drug or they have ADHD but are so bothered by the side effects of the medication that they take it rarely if ever. (Titration of an effective dose of stimulants for ADHD with minimal side effects can be difficult and sometimes impossible).

Although for the majority of people the occasional nonprescription use of stimulants as a study aid or recreational drug is not likely to do harm, a minority will experience significant problems including addiction, irritability, tics, high blood pressure and even sudden death (in people with unrecognized underlying cardiac problems). There is also the risk of alcohol poisoning from very high blood alcohol levels that occur when people "pre-treat" themselves with stimulants so they can stay up later and drink much more on a binge than they otherwise could by avoiding the safety mechanism of passing out.

Unfortunately there's no way to predict ahead of time for people who don't have ADHD, who will be able to use stimulants without a problem and who will run into all sorts of difficulty.

For more information on ADHD visit the National Institutes of Mental Health Web site. For more information on potential side effects of stimulants got to the Food and Drug Administration Web site and click on amphetamine or methylphenidate.
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