Ritalin..yay/nay

Great Debates
21

Thanks, Tom, for a very well thought out posting. (read: of your typical caliber) I pretty much agree with all of it.

Yes, I understand the pressures on doctors such as you describe. This just underscores the importance of finding a doctor you trust. (Another example of this sort of thing is a doctor who advertises his specialty; i am not against such advertising, but I’d think twice before trusting his impartiality when he says I’m a good candidate for what he does. See the Lasic thread for more info.)

I can tell whether or not my son has taken his Ritalin, as you can. But as far as his friend, who seems to be unaffected — something fishy is going on here. The parents and doctor must have a screw loose to keep a kid on medication that has no observable affect, and I suppose that is a real possiblity, but I think it more likely that there’s more going on than you are aware of.

22

Kudos to DoctorJ for the farsightedness analogy. Much better than my headache one.

Much of the public refuses to accept ADD as a disabling medical condition, just as they refuse to accept near- and far-sightedness as a disabling medical condition.

Who remembers the medical drama of the 1980’s “St. Elsewhere” ?

One of my favorite scenes in the series occured in the cafeteria. The man working behind the counter was a burly tough-guy type, and Dr. Ehrlich was on-line. Ehrlich was the most “socially challenged” regular character, and decided to make fun of the fact that the worker had only one arm.

The counterman took offense at this, of course, and moved towards Dr. Ehlich in a very menacing manner, raised his fist towards Ehrlich’s face, and then very gently removed Ehrlich’s eyeglasses and placed them down, and asked, “What would you like for lunch?”

“Whaddaya mean? I have no idea! I can’t see anything?”

“Not my problem, gimp. Who’s next, please?”

(… or something like that. It was a long time ago.) I’ve been wearing my glasses for almost 40 years now, and that scene taught me a lot about how almost everyone is disabled in some way or another, and that really levels the playing field to help us be compassionate and supportive to one another without taking pity or feeling sorry about it.

Uhhh, sorry… I didn’t mean to hijack the thread. We now return to our debate on Ritalin:

23

Well, since there is no very clear way for the doctor to evaluate the effect on the kid except through the testimony of the parents, the doctor is probably “continuing treatment.” The parents either see an effect that I do not see or want to see an effect that I do no see.

Even in the worst scenarios, (short of a doctor writing prescriptions for every kid who has ever run down a school hallway), I doubt that there is evil intent behind over-prescribing MPH. I think that with any psychotrope there is simply a possibility of handling it quickly rather than doing an exhaustive test. My son’s neurologist is excellent; he demanded detailed descriptions of my son’s behavior from both his day care and his school teacher as well as our input, tested his blood for a number of allergies and other issues, and observed my son during several visits. Once my son was diagnosed and the medicine prescribed, however, future doses were adjusted pretty much on our say-so. (My wife has a professional relationship with the doctor that may have influenced his decisions, there.) I think that the average GP (or even FP) that sees lots of patients all the time may simply not have the time to do everything our neurologist did. I don’t think anyone is being deliberately lax, but, as Dr. J mentioned, as a fairly safe drug, it is easy to prescribe.

I’m willing to admit I don’t know everything that goes on with the neighbor kid. Since the AMA or APA (I forget which) has stated that they believe that there is a bit of over-prescribing going on, I tend to see the neighbor as an example. (The neighbor is definitely a white male and we are definitely in an upper-middle-class neighborhood–although we live on the poor side of town.)

Tom~

24

I am continually stunned by the public’s willingness to vilify drug use while simultaneously shoving drugs down their kid’s throat.

It is a fact that a HUGE, growing number of American children are on Methylphenidate. Somewhere in the 4% range. That is tragic.

It is also fact that far more American children are on Methylphenidate than any other nation’s children. Why is this?

It is my opinion that the main cause of ADHD is cultural. I’m not saying you are a bad parent because your son is hyper. I am saying that most children have short attention spans and are often hyperactive and this is made worse in our society by rapidly-moving, loud video games, movies, television programs, electronic toys, violent programming, a diet of pizza, fast food, candy, gum, and a lack of discipline, balanced meals and proper supervision.

I acknowledge there are some children who actually have need of drug treatment, but nowhere near the amount Ritalin is being prescribed for. Your child may actually require this type of treatment - I would get about four unbiased professional medical opinions (difficult due to time and the inherent bias of doctors with regards to drug companies)

I have taken Methylphenidate several times as recreation in high school and loved it - it is an amazingly strong, clear high. It is also addictive. I can not imagine why any parent would give it to their child. I took about five times the prescribed dosage, so I have nothing scientific to add to any discussion of the actual side-effects of proper treatment.

Peter Breggin is making money in the media, yes, but I think his message is good and have yet to hear any lies being spread by him (tomndebb, what are these lies you are accusing the doctor of telling? Or was that simply slander?)

Yet to be reconciled with the reality of the dark for a moment, I go on wandering from dream to dream.

25

Tom wrote

The strange thing is, I say similar things about my kid’s several doctors, and I hear similar things from all the other people I know who have kids who are on Ritalin. Which leaves me wondering how many irresponsible rx-writers are really out there. Seems like not too many, to me.

I really can’t argue with Sake Samurai’s suggestion that ADHD can be caused by cultural factors. I’ve often suspected this myself. It would be great to change the culture to prevent it to begin with, but (a) you know how difficult that is, and (b) once a person has the ADHD, fixing the surroundings may not get rid of the ADHD. So what is wrong with treating it with a medication?

A person with an upset stomach knows damn well that it is a result of what he ate. Depending on how sensitive his system is, he may or may not be able to avoid that food on future occasions. In any case, he has a real problem in the here and now that can be easily remedied with a couple of Rolaids. Are you going to tell him that his condition is culturally induced and he shouldn’t take the medication, and that antacid abuse is rampant in today’s America?

26

Sake, that would be libel since this is a text medium. Slander is for spoken assertions. I have not libeled him, however.

His lies include:

I defy you (or Breggin) to submit substantial, peer-reviewed evidence for any of these four distortions. (The second two points are rank distortions. As nearly as I can determine, the first two points are untrue, fabricated, false, lies.)

As to your experiences, so what? Unless you are classically ADHD, the effect is not going to be the same on you. The effect on even ADHD patients is not uniform as it is certainly true that we have not established all the relationships between drugs and the brain. (I know two people who have taken nitro by accident and one idiot who took it on purpose without perceiving any effect on their heart rates. Should we conclude that heart disase patients should not bother taking nitro?) This does not mean that the drugs are not valuable, only that that aspect of medicine is still in its infancy.

As to your claim that it is addictive:
No.
If you have an addictive personality, you may have developed a psychological dependence (as a few users of pot find that drug). I do not know a single child using Ritalin who has suffered any withdrawal symptoms or who has had any problems “giving it up” when it was stopped for any reason. (If you got that from Breggin, you can add it to his lies.)

Tom~

27

As near as we know, the brains of ADD people do not produce high enough levels of dopamine or other internal stimulants. So the brain is chemically under-stimulated. Often the response in children is to seek the stimulation they lack by acting out, causing chaos, etc. The lack of internal stimulation also causes the brain to be unable to focus constistently.

So the nonsense above about Ritalin working because it caused the brain to malfunction is almost exactly the opposite of what’s really happening. If a person is truly ADD, then stimulants will cause the brain to function in a normal way.

A new study out shows that nicotine may stimulate the brain in the same way, improving concentration etc.

The rapid increase in ADD diagnosis has somewhat correlated with the decreased use of tobacco products in our society. It may be that the widespread use of tobacco was partially an unknowing way to self-medicate ADD symptoms.

28

Sam: Could you provide a link for the nicotine study. I realize that I was simply being a smart-ass before, but I am genuinely curious, now. Particularly since I’m considering quitting smoking by using the patch.

All thanks-
Waste
Flick Lives!

29

come on guys, most of the posts here are B.S (some of them are sooooo far off you people should be kicked off the message board!!), there are only 4 people who even know what their talking about. Dopamine is NOT-regulated in the add brain. It’s in- consistant. Ritilin is addictive (thats why it’s sch#2), but not to people with add (ok there is a very mild psychological addiction with some add people).

30

Regarding dopamine and regarding addiction:

According to the American Journal of Psychiatry, (October, 1998), (as reported in a synopsis provided to Reuters)

Since the discussion is concerned specifically with using Ritalin to treat ADD and ADHD, I will amend my statement to say that “In the context of treating ADHD, Ritalin is not addictive.”

Tom~

31

An interesting sidebar to ridalyn:

Ridalyn can be used in slow people to get them to go faster. I’m not talking about retarded folks (ohh, that wasn’t PC. Allow me to correct myself. Politicians. There. Better.) , but juuuuust sllloooow assssss moooollassses people. You know the kind. My brother is slower than a sloth
( much due to the MD) and was put on ridalyn to see if it would speed him up as well as keep him awake. ( He could sleep 18 hours a day.) It doesn’t work on his case because he’s so severe, but on others, it has.

32

Dicey topic–ritalin and kids. For what it is worth, I was diagnosed with ADD as an adult, and I found ritalin very helpful during the period of adjustment (mostly of habits and attitudes) afterward. After I made some modifications to my life to better accomodate my mental “style”, I stopped taking the drug. A positive experience.

“I don’t get any smarter as I get older–Just less stupid”

33

I object to anyone drugging anyone to get them to do what society expects regardless of their own wishes.

34

So do I, Matt. However, leaving aside Dr. Breggin’s little forays into propaganda, that has nothing to do with the topic.

Tom~

35

I think it does. I think we are talking about chemically manipulating someone’s personality to make them more tractable, than which few things are more heinous.

36

I do not want my son to be more tractable. I want my son to be able to express himself in any way that does not bring physical harm to himself or others. I want him to be able to set out to achieve a goal that he has set for himself and carry through until it is complete rather than looking back on hundreds of never-completed tasks in utter frustration.

Your assertions follow the unsupported claims of Dr. Breggins. They are not true. (That is why I earlier called Breggin’s statements lies.) The “personality” is not manipulated. My son is every bit as obstreperous, argumentative, feisty, and idiosyncratic on Ritalin (now on Dexedrine) as he ever was off the drug. The difference is that he controls the level to which he wants to take his expression and he is able to assess the consequences of his actions. Without the medication, he is not capable of those judgments.

A “normal” rambunctious kid would not be sedated by Ritalin, he would be given an amphetamine high. An ADHD kid on Ritalin does NOT become more biddable. He is given one tool to allow him to control himself. ADHD kids on Ritalin are still active, self-determining, individuals. If you have ever seen any other result, either the child was seriously over-medicated or some other agent was at work.

Tom~

37

My own childhood experiences with ritalin were excellent. I was very hyper, & my schoolwork was enormously improved. I chose to stop using Ritalin on my own at about age 18. No problems with stopping, either. 10 years of use.

Always get multiple opinions, though. If you have any family history of clinical depression, you may have a misdiagnosis.

If both docs say “He’s hyper” get the Ritalin. It works well. My own experience says so.

It matters not whether you win or lose; what matters is whether I win or lose.

38

This is like saying that you would object to giving near-sighted kids glasses because society expects them to see. Ritalin is not a mind control drug. It is a drug that helps them to focus, whereas otherwise they cannot.

And no ethical physician will force a kid to take the drug against their wishes. The matter is discussed with the kids, and a mutual decision is reached.

t “ad” dn

39

Deep breath… here we go. ADHD is a difference in the way some people’s brains work. In a normal person, when we concentrate, our prefronyal cortex inhibits other areas of the brain - so, we tune out external (noises, visual info, physical sensations) and internal (emotions, memories) distractions. In people with ADD, the opposite happens: when they focus attention, the prefrontal cortex quiets down, and they are flooded with distractions and awareness. Why are about 5% of our adolescents like this? Think about it: picture yourself as a member of a native American tribe 4000 years ago. You are hanging out around the fire, eating and talking. Uncle Fuzzy Bear is telling a great story, and you are completely absorbed. You don’t hear the twig snap 100 yards away… but your friend with ADD does, and alerts you to the rival raiding party sneaking up on you. You survive. People with ADD have been very good to have around. Also - they breed at a younger average age, and they move 4 times as often as “normal” people. So - who got fed up faster with the horrors of industrial Europe and immigrated to America? ADD people. They are our hunters, explorers, artists and warriors. God bless the annoying critters. So what about Ritalin, Tobacco, Cocaine, and Crystal Meth? They all increase dopamine availability in the prefrontal cortex, allowing the ADD person to use his own brain to run itself. Ritalin and dexedrine are speed, just a very clean and controllable brand of speed. People who are properly medicated and treated for ADD are only half as likely to become substance abusers. These facts are mostly courtesey of Dr. Daniel Amen - see www.amenclinic.com for more info, and MindWorks Press for some really useful books. As a psychotherapist who works with adolescents, and who is married to and the father of several ADD people, I can speak to the usefulness and scientific veracity of Dr. Amen’s work. As to the knuckleheads on Oprah…don’t believe 'em. ADD is a useful genetic trait, and we need to stop oppressing and blaming ADD people.

40

Exactly. ADD isn’t so much a disorder as a different way of thinking. The ADD mind is better at some things, and worse at others. It’s only when our society started to require more jobs that required long periods of concentration and focus along with low activity that this really started to become an issue.

Take an ADD person and make him work as a secretary or a data entry operator, and chances are he’ll be miserable. Complicate his life with lots of paperwork and daily and weekly chores, and he’ll be forgetful and screw up. He’ll hate his job, get yelled at by his wife for forgetting things all the time, etc.

Take that same person, and make him a Pilot, or a Police Officer, or a Rock Musician, or a Fireman, or Actor, or Stock Exchange Floor Trader, or any number of other jobs that let the benefits of the ADD mind shine through, and he’ll be happy and fulfilled. ADD people are often more intelligent and more creative than average, they have the ability to hyperfocus on tasks that really stimulate them, and they often have faster reaction times and deal with emergencies very well (the rush of brain chemicals in an emergency may actually cause them to calm down and perform even better).

This “Hunter vs Farmer” explanation of the ADD brain has come up before. One reason why North American Native People have such a hard time fitting into society is that they may be genetically predisposed to being more ADD, because their culture and lifestyle in the fairly recent past rewarded it.

A psychologist investigating this link did a study of Inuit schoolchildren, and found one school where 100% of the kids were on Ritalin.