I’ve received a surprising number of phone calls from parents asking me what I know about the long-term effects of Ritalin and Adderall. Their physicians had recommended their young children or college-age students take these medications either because they were hyperactive, had been diagnosed with attention deficient disorder, or simply needed help studying to possibly enhance their grades. The most common questions were:
* What are the long-term side effects?
* What are the immediate side effects?
* Are there any other ways to deal with issue-impacting hyperactivity and to increase study ability?
The answers are both simple and complex. And I have definite opinions about the use of these drugs.
There are in fact minimal studies indicating their long-term effects. However, as in the rest of our “fast food nation,” few people asking actually care. The prevailing attitude is “if popping a pill gives immediate relief and results, we’ll take it.”
While there is no question that in many cases these drugs are useful, there is also no question that more often they are the first line of defense with little thought given to what else may be utilized.
Witness my story about my friend, a successful businessman now in his seventies and the prototype for the move Dirty Dancing. “Bill,” I asked him one day. “How did you become such a fabulous dancer?”
“Dorree,” he said, “I was a wild kid in Brooklyn. Mom was from the old country, what did she know about drugs? She didn’t know how to control me, so she put me in dancing school. I loved it and it kept me out of trouble. Today they probably would have had me on half the drugs out there. I’m a dinosaur. I still believe parental attention, focused activity and the ability to play freely is what most kids need. Play dates? Who ever heard of all this structured stuff? We were all too busy living our lives. We had fun. As we got older, we had sex, and we partied, yet were good kids. Our parents were around and we would do little to disappoint them.”
Ritalin (http://www.drugs.com/ritalin.html) is a mild central nervous system stimulant. It affects chemicals in the brain and nerves that contribute to hyperactivity and impulse control.
Ritalin is used to treat attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), and narcolepsy (an uncontrollable desire to sleep). When given for attention deficit disorder, Ritalin should be an integral part of a total treatment program that includes psychological, educational, and social measures.
Adderall (http://en.wikipedia.org/wiki/Adderall) is also reportedly widely used as a “study drug” at most major American universities. Adderall is reported to help focus energy and concentration to a much higher level than normal. It is an amphetamine, enabling the user to focus and stay awake. Stories of students writing papers for an unusual number of continuous hours [e.g., 14 hours], or cramming all night for an exam with no loss of energy or concentration are common. However, the user reportedly can suffer from drastic side effects the following day if Adderall was used to avoid a normal sleep pattern. These reported side effects include temporary loss of vision, sleeping over 14 hours, muscle spasms, vomiting, mental confusion, etc. William Frankenberger, psychology professor at University of Wisconsin at Eau Claire, led a study at the university in 2004 that reported 14% of the campus had abused some form of ADHD drug, including Adderall. College campuses known to be highly competitive or have a high rate of binge drinking had up to 25% of students who misused an ADHD medication within one year, a survey of students at 119 colleges across the country concluded.
So, yes there are side effects, including appetite suppression and weight loss, mood swings irritability and sleeplessness. Adderall has also been used as an off-label drug for obesity. The use of Adderall is generally not advised in those persons with pre-existing cardiac or mental illnesses. It is also not advised in persons who have a history of drug abuse. Although FDA safety advisors voted 8 to 7 to issue a black box warning (http://en.wikipedia.org/wiki/Black_box_warning), the FDA’s pediatric advisory committee refused to give the drug its most severe black box warning in March 2006. A Black Box Warning regarding amphetamine abuse potential is in place, however.
Also, there is now a move to use these drugs with children who appear to have depression. In fact the AMA has published draft guidelines indicating that children and adolescents between 6 and 17 years old who are receiving medical care should be interviewed for signs of depression. In the section on psychotherapy referral, the underlying contempt for psychotherapy is belied in the prose. The section reads as follows:
“The following clinical recommendation statements are quoted verbatim from the referenced clinical guidelines and represent the evidence base for the measure:
“Education, support, and case management appear to be sufficient treatment for the management of depressed children and adolescents with an uncomplicated or brief depression or with mild psychosocial impairment.”
Well in my opinion, this is hogwash.
Although psychotherapy is recommended for children and adolescents with a diagnosis of major depressive disorder, research has indicated that it is currently underutilized and declining in use. In 2001-2002, approximately 68% of children and adolescents being treated for major depressive disorder received psychotherapy or mental health counseling, a 15% decrease from 6 years earlier. Since, 16-19 percent of these patients die and inadequate assessment and partial treatments, such as medication-only approaches and failure to refer for specialist assessment and individual and family psychotherapy, contribute to the risk, these guidelines appear to show inadequate knowledge, training, and philosophies.
What would happen if we slow down a little, pay attention to ourselves and our kids and simply enjoy ourselves as families? Remember the play ‘Stop the World I Want to Get off?’ Well there’s a message in that musical… slow down; we are going too fast. Let’s let the moments last. Our kids will be better off and so will we. If we are FiftyandFurthermore, we ought to have enough life experience to educate those younger than we are that life is a series of learning, and that not every seemingly off-beat response necessarily needs to be fixed by a popping a pill.
Previously Published in 2008