ADHD Medications

What about ADHD medications?

In earlier blog posts we've discussed ADHD and its symptoms. I get lots of questions regarding ADHD medications. What’s wrong with medicating a school-aged child? And, even more disturbing, is the growing trend to prescribe these medications to preschool children aged 1-3. Because of how the brain matures, issues with reasoning, emotions and problem-solving are common and appropriate at this age. The frontal lobes that are so crucial in reasoning, planning, movement, emotions, and problem solving do not mature until between 15 and 21 years of age. Since ADHD medications typically work primarily in the prefrontal cortex, it seems to make little sense to prescribe it to infants. In addition, children are no longer just taking the medicines for a few years during grade school but are encouraged to stay on them into adulthood.

ADHD adults still struggle with the symptoms even though many are not reported as ADHD because by adulthood they have resorted to self-medication with alcohol, caffeine, cigarettes or illegal drugs. They have a high rate of unemployment, lost jobs and broken relationships. Why is this happening? Some clinicians are managing the symptoms instead of treating the root cause and it has created a growing epidemic.

ADHD medications prescribed to children and adults include methylphenidate (Ritalin, Concerta) or an amphetamine (Adderall, Vyvanse). It is important to note that these medications are not a total cure! They are a Band-Aid® for symptoms…when they work at all. The other thing is that they actually change brain chemistry—and not for the better. Medications such as Methylphenidate (Ritalin®, Concerta®, Methylin®), Dextroamphetamine (Dexedrine®, Dextrostat®), Amphetamine: combined dextroamphetamine and levoamphetamine (Adderall®) and Lisdexamfetamine (Vyvanse®) are all typical first line medications for ADHD and they are stimulants. They create a “high” giving the user elevated mood, increased feelings of well-being, and increased energy and alertness. They are in the same class as cocaine, methamphetamine, amphetamines, nicotine, and MDMA (methylenedioxymethamphetamine), better known as “Ecstasy.”

Although stimulants are usually the first choice prescribed to treat ADHD, non-stimulants (e.g., Intuniv™, Strattera®) also may be used. Guanfacine Hydrochloride (Intuniv) was originally created to help control high blood pressure. This medication reduces nerve impulses to the heart and arteries; this slows the heartbeat, relaxes the blood vessels, and thus reduces blood pressure. Intuniv was approved by the FDA for limited use. Eight to nine weeks are usually the limit this drug should be taken. Longer use has not been tested. The side effects for this drug are noted in Table 1.:

Table 1. Side Effects for GuanfacineHydrochloride (Intuniv)

• Abdominal pain 
• Constipation 
• Fatigue 
• Headaches 
• Impotence 
• Dizziness 
• Dry mouth 
• Excessive sleepiness (somnolence) 
• Low blood pressure (hypotension) 

Discontinuing Intuniv abruptly may result in nervousness, rapid pulse, anxiety, heartbeat irregularities, and so-called rebound high blood pressure.

Strattera is also a non-stimulant. However, Strattera is chemically similar to tricyclic antidepressants, an older class of drugs that have long been known to occasionally induce mania in people with bipolar illness. In 2004 the FDA recommended a label warning potential for severe liver injury to be placed on Strattera. In 2004, the Journal of Pediatrics noted concern about Strattera's potential to induce extreme mood swings, which could lead to suicidal thinking: "Our clinical experience [with Strattera] has been that mood destabilization is a much more prevalent risk than was observed."

During Strattera’s clinical trials, two physicians wrote a letter to the Journal of Pediatrics. The doctors, Theodore Henderson of Denver and Keith Hartman of Osceola, Wis., noted that a third of 153 children treated with Strattera at two clinics in their areas manifested extreme irritability, aggression or mania—a state of wild excitement typified by racing thoughts, insomnia and inappropriate acts—soon after going on the drug. Three had to be hospitalized, including one 11-year-old boy who stripped off his clothes, covered his body with markings using a felt-tipped pen, flew into a screaming rage and threatened family members with a sword belonging to his father. Three others were incarcerated in juvenile detention centers for violent behaviors.

Table 2. Side effects for Strattera:

• Liver problems 
• Depression 
• Psychosis 
• Abnormal thought patterns 
• Tendency to self-injury 
• Dry Mouth 
• Insomnia 
• Abdominal pain 
• Constipation 
• Sweating 
• Dysuria 
• Sexual problems 
• Weight change 
• Palpitations and increased heart rate 
• Increase blood pressure 
• Decreased appetite 
• Dizziness 
• Fatigue (tiredness) 
• Headache 
• Mood swings 
• Nausea and vomiting 

Besides the obvious risks, studies have now shown that, in the end, if these drugs work at all, they are only a short-term fix. The 8-year follow-up data from the ADHD MTA Study (Multisite Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder) suggests that the use of ADHD drugs for a period longer than 2 years is ineffective.

So the bottom line is, just because they call them ADHD drugs, it doesn’t mean that they’re harmless. Since 2006, the FDA has labeled all ADHD medications with their “black box” warning, meaning they carry significant risk of serious or even life-threatening adverse effects. ADHD drugs are a class II narcotic. The warning was placed on these drugs for an increased risk of sudden death and serious cardiovascular problems but as you can see there are many other issues to be aware.

Call BrainAdvantage today for more information.

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