The Athlete's Way

Sweat and the biology of bliss

Are Pharmaceuticals the Answer for Treating ADHD?

New study suggests using antipsychotics and amphetamines for some types of ADHD.

I agree with Psychology Today blogger Robert Berezin, M.D.—The New York Times article, “The Selling of Attention Deficit Disorder” by Alan Schwarz is courageous. In his response to the article Berezin says, “As a practicing psychiatrist for forty years, I take the condemnation of the use of amphetamines a step further. There is no place for the use of amphetamines in psychiatry or medicine, never mind for children.” Berezin adds, "We need to go back to the 60s and 70s and before, when there was no ADHD."

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In November of 2013 I wrote a Psychology Today blog post titled “One More Reason to Unplug Your Television.” My post offers some potential non-pharmaceutical options for slowing the ADHD 'epidemic' based on The Athlete's Way.

My PT blog post was inspired in part by a study published in the upcoming January 2014 Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) that seemed to support the labeling of ADHD as a disorder and implied that doctors should increase the use of ADHD medications. The conclusion of that study stated:

"Approximately 2 million more U.S. children/adolescents aged 4 to 17 years had been diagnosed with ADHD in 2011, compared to 2003. More than two-thirds of those with current ADHD were taking medication for treatment in 2011. This suggests an increasing burden of ADHD on the U.S. health care system. Efforts to further understand ADHD diagnostic and treatment patterns are warranted."

Amidst all the debate about ADHD medications in the news, I was surprised on December 20, 2013 to read a headline declaring “Study Shows 2-Drug Combo Helps Adolescents with ADHD, Aggression.” These new findings (which offered advice to take more pharmaceuticals to treat ADHD,aggression) are also being published in the upcoming January 2014 Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP). The new recommendation from these researchers is to prescribe both an amphetamine and an antipsychotic for children 6-12 diagnosed with “ADHD, Aggression.”

Risperidone and Amphetamines as an ADHD Treatment?

The antipsychotic drug the study recommends is called Risperidal. Please take a few moments to click on the link and read the medical uses, adverse effects, and withdrawal symptoms. As the father of a 6-year-old, I am particularly passionate about the importance of not over-medicating young, vulnerable minds with potent pharmaceuticals, let alone antipsychotics designed to treat schizophrenia.

The new study which was conducted in conjunction with the University of Pittsburgh, Stony Brook University in New York and Case Western Reserve University in Ohio concluded that “Prescribing both a stimulant and an antipsychotic drug to children with physical aggression and attention-deficit/hyperactivity disorder (ADHD), along with teaching parents to use behavior management techniques, reduces aggressive and serious behavioral problems in the children.”

First author Michael Aman, director of clinical trials at Ohio State's Nisonger Center and emeritus professor of psychology said in a press release, "Combination pharmacotherapy is becoming common in child and adolescent psychiatry, but there has been little research evaluating it. Our findings may be considered somewhat controversial because they appear to support the use of two drugs over one for treating children with aggression and disruptive behavior when things do not seem to be going well. Many practitioners have been taught to 'Keep things simple and safe' in their medical training. In general, this is good advice."

For the "Treatment of Severe Childhood Aggression (TOSCA) Study," 168 children ages 6 to 12 who had been diagnosed with ADHD and displayed significant physical aggression were divided into two groups. All study participants received a psychostimulant drug called OROS methylphenidate and their parents received behavioral parent training for nine weeks. The researchers called this treatment combination "basic" because both are evidence-based and have been shown to be helpful for improving both ADHD and aggression.

Are antipsychotics mixed with speed the best way to treat adolescent “ADHD-Aggression"?

Researchers wanted to see if they could expand or augment this treatment by adding a second medication. If there was room for improvement at the end of the third week, a placebo was added for the "basic group," while the antipsychotic drug risperidone was added for participants in the "augmented group."

I haven’t seen “One Flew Over the Cuckoo’s Nest” since I was a teenager ... But reading about this study gave me nightmarish Nurse Ratchet flashbacks to some of the more disturbing scenes in that movie. I would definitely not want to have myself or my child in the “augmented” arm of this experiment. Again, it goes against common sense to pump young children diagnosed with ADHD full of potent antipsychotics with such adverse side effects. One has to wonder if there is some other type of agenda going on that is driven by big pharma profit margins.

"We conducted this study because we viewed the combination of ADHD and significant physical aggression—especially the aggression—as a serious situation," Aman stated. "It is not uncommon to use more than one medicine for other serious situations, such as when treating cancer or epilepsy for instance. Although doctors have often used stimulants and antipsychotics together in recent years, we did not have good evidence until now that they would work more effectively when carefully staged and given together."

Aman also acknowledged, “While there is always some risk with the addition of a second drug to the treatment package, the two drugs seemed to neutralize some of each other's potential side effects. For instance, children in the augmented group did not seem to have as much trouble falling asleep, once the risperidone was added.”

Personally, it doesn’t seem there is much to celebrate in terms of giving a child speed along with an antipsychotic and noting that they ‘neutralize’ each other because the ‘risperidone’ makes it easier for the adolescent to fall asleep. It reminds me of giving young MGM Hollywood stars like Judy Garland speed during the day and barbituates at night. For "Dorothy," this regular dose of uppers and downers led to addiction and a lifelong struggle with drugs, which led to her early death at age 47. Garland always blamed MGM for robbing her of her youth.

Conclusion: When are Pharmaceuticals Necessary?

There are clearly cases when pharmaceuticals dramatically improve a person’s physical and mental health. Every individual and parent needs to remain vigilant about knowing when medication is going to be beneficial in both the short and long-term. This is a hot button topic and one surrounded by much controversy and passionate discourse.

I wrote this PT blog as a response to Dr. Robert Berezin’s well informed Psychology Today blog post titled "Reflections on 'The Selling of Attention Deficit Disorder'." My aim is to keep PT readers updated with developments on this issue in the hopes that it will advance a constructive discussion among the general public, parents, doctors, and experts in the field.

Follow me on Twitter @ckbergland for updates on The Athlete’s Way blog posts.

Christopher Bergland is a world-class endurance athlete, coach, author, and political activist.

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