Adderall
Ritalin Concerta Side Effects in Adults and Child Medication
Confirming the Hazards of Stimulant Drug Treatment
By Peter R. Breggin, M.D.
Until recently, no studies have
systematically examined the rate of psychotic symptoms caused by
routine treatment with stimulant drugs such as Concerta,
methylphenidate (Ritalin) and amphetamine (Dexedrine,
Adderall). Doctors who prescribe stimulant drugs often
seem oblivious to the fact that they can cause psychoses,
including manic-like and schizophrenic-like disorders. Without
providing a scientific basis, the literature often cites rates of
1% or less for stimulant-induced psychoses (reviewed in Breggin,
1998, 1999). Recently on television I debated a well-known expert
in child psychiatry who took the position that prescribed
stimulants "never" cause psychoses in children.
The rate of psychotic symptoms that
first appear during stimulant treatment has recently been
investigated in a 5-year retrospectives study of children
diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) (Cherland
and Fitzpatrick,1999). Among 192 children diagnosed with ADHD at
the Canadian clinic, 98 had been placed on stimulant drugs, mostly
methylphenidate. Psychotic symptoms developed in more than 9% of
the children treated with methylphenidate. According to Cherland
and Fitzpatrick, "The symptoms ceased as soon as the medication
was removed" (p. 812). No psychotic symptoms were reported among
the children with ADHD who did not receive stimulants. The
psychotic symptoms caused by methylphenidate included
hallucinations and paranoia. The authors conclude that, due to
poor reporting, the rate of stimulant-induced psychosis and
psychotic symptoms was probably much higher.
In my practice of psychiatry, I am
frequently consulted about children who are taking three, four,
and sometimes five psychiatric drugs, including medications that
are FDA-approved only for the treatment of psychotic adults. The
drug treatment typically began when the children developed
conflicts with adults at home or at school. In retrospect, the
conflicts could easily have been resolved by interventions such as
family counseling or individualized educational approaches.
Usually under pressure from a school, the parents instead
acquiesced to put their child on stimulants prescribed by
psychiatrists, family physicians, or pediatricians.
When these children developed
depression, delusions, hallucinations, paranoid fears and other
drug-induced reactions while taking stimulants, their physicians
mistakenly concluded that the children suffered from "clinical
depression," "schizophrenia" or "bipolar disorder" that has been
"unmasked" by the medications. Instead of removing the child from
the stimulants, these doctors mistakenly prescribed additional
drugs, such as antidepressants, mood stabilizers, and neuroleptics.
Children who were put on stimulants for "inattention" or
"hyperactivity" ended up taking multiple adult psychiatric drugs
that caused severe adverse effects, including psychoses and
tardive dyskinesia.
It is time to recognize that the
supposedly increasing rates of "schizophrenia," "depression," and
"bipolar disorder" in children in North America are often the
direct result of treatment with psychiatric drugs. They should be
classified as adverse drug reactions, not as primary psychiatric
disorders. Doctors need to become more expert at identifying these
adverse drug reactions in children and more aware of how and why
to taper children from psychiatric medications (Breggin and Cohen,
1999).
When parents are willing to take a
fresh approach to disciplining and caring for their children, or
when the children's school situation can be improved, it is
usually possible to taper them off of all psychiatric medications.
The parents are then relieved and gratified to see their children
increasingly improve with the removal of each drug.
What's the answer to this
widespread, unwarranted use of medication in the treatment of
children? As long as we respond to the signals of conflict and
distress in our children by subduing them with drugs, we will not
address their genuine needs. As parents, teachers, therapists, and
physicians we need to retake responsibility for our children (Breggin,
2000). We must reclaim them from the drug companies and their
advocates in the medical profession. At the same time, we must
address the needs of our children on an individual and societal
level. On the individual level, children need more of our time and
energy. Nothing can replace the personal relationships that
children have with us as their parents, teachers, counselors, or
doctors. On a societal level, our children need improved family
life, better schools, and more caring communities.
Bibliography
Breggin, P. (1998). Talking Back to
Ritalin. Monroe, Maine: Common Courage Press.
Breggin, P. (1999).
Psychostimulants in the treatment of children diagnosed with ADHD:
Risks and mechanism of action. International Journal of Risk and
Safety in Medicine, 12, 3-35
Breggin, P. (2000). Reclaiming Our
Children. Cambridge, Massachusetts: Perseus Books.
Breggin, P. and Cohen, D. (1999).
Your Drug May Be Your Problem: How and Why to Stop Taking
Psychiatric Medications. Cambridge, Massachusetts: Perseus Books.
Cherland, E. and Fitzpatrick, R.
(1999, October). Psychotic side effects of Psychostimulants: A
5-year review. Canadian Journal of Psychiatry, 44, 811-813.
(reprinted from Vol. 2, Issue 3,
Ethical Human Sciences and Services, in press)
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