The Stimulant Panacea?

The Stimulant Panacea

Stimulants (amphetamines and methylphenidate) increase the availability of dopamine, a neurotransmitter associated with attention and pleasure, to the frontal cortex of the brain.  The goal of using this treatment in an individual diagnosed with ADHD, is to improve his or her focus as well as his or her ability to regulate other emotional responses.

The use of stimulants to treat an ADHD diagnosis has increasingly become standard practice.  The United States, which accounts for less than 5% of the world’s population, consumes over 85% of the world’s stimulants and over two-thirds of kids diagnosed with ADHD in the U.S. receive daily stimulant medication treatment1.

Though a tempting solution, prescribing stimulants should be done with caution as these medications often not only fail to address the root cause of inattention, but can be accompanied by severe and pervasive consequences.

NEGLIGENT PRESCRIBING

In the United States, a recent study revealed stimulant prescription practices for ADHD do not reliably follow guidelines recommended by the American Academy of Pediatrics, including documentation that diagnostic criteria have been met, consideration of alternative therapy options, and continuous monitoring of the patient’s response to any treatment, including medication2. In fact, while 93% of children diagnosed with ADHD were receiving stimulant medication, 30% lacked proper diagnostic criteria for the disorder, and over 50% were not monitored for response to medication after one month1.

Many doctors fail to measure levels of dopamine when deciding to prescribe stimulants, instead basing this decision on manifested symptoms of inattentiveness, which can lead to a broad spectrum of side effects and consequences.

STIMULANT SIDE EFFECTS AND CONSEQUENCES

According to stimulant manufactures, the drugs can bring on “new or worse aggressive behavior”, “new psychotic symptoms or new manic symptoms” and commonly cause weight loss and trouble sleeping. Some children experience paranoid feelings (bugs crawling), while others manifest facial tics. One scientific study found 48% of subjects who took ADHD medications experienced side effects like sleep problems and “mood disturbances.” In another, 6% of children suffered psychotic symptoms, including thoughts of suicide5.

Given that stimulants can also produce euphoria, they are prone to abuse and addiction. Stimulant medications also carry the risk of abuse by non-patients, with estimates for high school student abuse of prescription stimulants ranging from 15% to 40%3. Despite the risk of abuse, these medications are being made even more widely available.  The most recent Diagnostic and Statistical Manual of Mental Disorders (DSM-V) increased the window for diagnosis by 5 years, meaning that 20 million more children are eligible to be diagnosed as ADHD.

Medication provides students with a temporary crutch that, when removed, may set them up for failure. At the same time, they add risk: stimulants such as Adderall and Ritalin can be habit forming, and tolerance builds over time. This means that more of the drug is required to produce equivalent effects, further increasing the risk of adverse side effects or abuse4. Patients are faced with four major possible outcomes (see table below) when blindly treat inattentiveness with stimulants.

 

  SOLVES ROOT OF THE PROBLEM DOESN’T SOLVE ROOT OF THE PROBLEM
CAUSE SIDE-EFFECTS

 

the medication solves the problem, but with some adverse side effects

 

the medication does not solve the problem, and causes additional problems
NO SIDE-EFFECTS

 

 

the medication solves the problem, and there are no undesired effects

 

the medication does not solve the problem, but causes no negative side effects

 

A HOLISTIC APPROACH

The temptation to resolve inattentiveness through a pill is understandable: we cannot learn if we do not pay attention, and we cannot pay attention if we constantly indulge impulses to seek distraction. If a pill can help us resist the tendency towards distractibility, it should improve our attention, and therefore our learning.

Indeed, in some cases, this logic is sound; medication is likely the only solution for serious cases of ADHD. In many other cases, though, inattentiveness is merely a symptom of a more complicated cognitive weakness.

Complex relationships between many factors can result in manifested symptoms of inattenton. Though increasing the brain’s access to dopamine is suitable for those with a deficit, this is not the case for all suffering from these barriers.  A holistic approach is not only more effective, but mitigates the risks of what are becoming commonly experienced side effects of misuse and abuse of these medications.

 

End Notes

1 J. Epstein et al., “Variability in ADHD care in community-based pediatrics,” Pediatrics 134 (2014): 1136-1143

2 D. Rabiner, “Study finds large gaps between research and practice in ADHD diagnosis and treatment,” Sharpbrains, 2014.

3 a. Schwarz, “Risky rise of the good-grade pill,” The New York Times, 10 June, 2012: A1.

4 United States Food and Drug Administration, “Adderal XR prescribing information,” 2013.

5 Psychiatry, April 2010; The Canadian Journal of Psychiatry, October 1999.