Friday, June 24, 2005

Drugging Children

I am deeply disturbed by the use of psychotropic drugs in children.

You could argue that half the biological determinants of children learning and behavior problems are in the genes and the other half are in the food and the environment. You can also argue that if the biological determinants are wrong, the best parents, best schools and most supportive community will fail to produce sane, happy, productive adults.

The problem may be concealed in the environment as an agent X, a chemical hidden in air pollution, or a protein in milk or bread that interferes with brain function. Or, the problem might be more obvious, such as young children wired on colas or older children drunk on beer and stoned on marijuana.

When you take a child suffering from bad chemistry to the psychiatrist and he prescribes antidepressants, Ritalin or amphetamines, you do not get a healthy sane child, you get a worse mix of bad chemicals.

Attention deficit hyperactivity disorder (ADHD) is a descriptive term that refers to restless, distractible children who have a knack for disrupting any environment that tries to enclose and control them. They have poor impulse control, often display abrupt mood swings, have inappropriate anger, and sometimes are violent. Their schoolwork suffers from inattention, disorganization, poor memory, and behavior disruptive of an otherwise orderly classroom.

Several theories have been advanced to explain ADHD. The theory of "minimal brain damage or dysfunction" had many advocates. The child is viewed as having a fixed disability, manifesting a structural problem of brain, acquired during prenatal development or at birth. Language disability or dyslexia has also been attributed to a fixed circuitry problem in the brain that impairs encoding and decoding of language symbols. The brain-damage theories ignore the living, dynamic properties of the brain; they seem to view the brain as an appliance or computer that comes hardwired to behave in a certain way. But what about all the environmental factors that influence the growth and development of the brain? What about the molecular and cellular dynamics of the brain? What about the daily input of molecular substances to the brain through air, food and water?

"Sugar" was often blamed for hyperactivity. Parents often observe that children's' behavior deteriorates after eating sugar-containing foods, such as chocolate chip cookies, cake, jello, kool-aid, pop, strawberry ice cream, or chocolate bars. They blame “sugar” and do not think of other ingredients in the food as potential problems. The sugar and hyperactivity connection illustrates a mistake of attribution, blaming the results of the complex interaction of many food ingredients with the body on only one of the ingredients. When sugar (glucose and sucrose) alone is given to children, they tend to be sedated, with unchanged or even decreased physical activity.

Caffeine is major problem. Hirsch reported a 252% increase in ADHD scores (using the Connor’s scale) when children drank less than one can of caffeinated colas. Coca cola contains 44 mg per 12 oz can and Pepsi Cola 38 mg per can. High caffeine drinks such as Jolt and Red Bull are available in supermarkets and may be consumed by children.

The pharmacological approach to hyperactivity is based on an abstract, over simplified drug-neurotransmitter model of brain function. The dopamine system is involved in reward-seeking behavior, sexual behavior, control of movement, regulation of pituitary-hormone secretion, and memory functions. ADHD may be attributed to dopamine deficiency. Dopamine synthesis slowly increases as children grow and may not reach full capacity until late teens. This is one of the built-in maturation lags that prevents children from assuming more mature behavior in their early life. Dopamine in young animals exerts a protective influence against hyperactivity. Since schizophrenia is associated with increased dopaminergic activity and is improved by dopamine-blocking agents, there is a reciprocal relationship between psychosis and hyperactivity.

A drug treatment approach is designed to stimulate dopamine circuits. Drug options have included pemoline, L-dopa, bromocriptine, amantadine, and lergotrile. Ritalin and amphetamines increase dopaminergic activity and decrease hyperactivity while they increase stereotypy. Ritalin has become the "drug of choice" for children with ADHD. Any child treated with Ritalin is moved from the hyperactivity end of the spectrum toward a schizophrenia-like state. Ritalin therapy poses risks, some obvious and others concealed. The most obvious Ritalin effect is appetite suppression and retarded growth. Some parents complain that their Ritalin-treated child acts like a "zombie". They describe emotional blunting and detachment from family and friends, a schizophrenic attribute. Children on higher doses and with chronic use of Ritalin may manifest paranoid features: there is a tendency to be overly suspicious, to withdraw, to get angry, and to display restless, non-productive behavior.

People who abuse the related class of drugs, amphetamines, often develop a psychotic state with full-blown paranoia. Ritalin may also produce disruption of movement control in a few patients. Facial and head tics may appear and may progress to Tourette's syndrome which includes peculiar grunting and respiratory tics, associated with compulsive behaviors and explosive swearing.

Drugs that influence the dopamine system all show longterm adverse effects on the motor system and the psyche. Studies on the effects of long term Ritalin use show the mixed results expected from a symptomatic drug therapy that does nothing to remove the underlying cause of the disorder.

If you ask the question: Should children or adults with ADHD take Ritalin long term?  My answer is easy – definitely NOT.

Amphetamines are the second class of drugs used to treat ADHD. The amphetamines have a long history of use and abuse. A popular prescription version,  Adderall® and Adderall Xr®  ( a sustained release form) was withdrawn from the market in Canada after Health Canada issued a warning that there were 20 international reports of sudden death in patients taking either Adderall® (sold in the United States, not in Canada) or Adderall Xr® (sold in Canada). These deaths were not associated with overdose, misuse or abuse. Fourteen deaths occurred in children, and six deaths in adults. [i] 

Should children or adults with ADHD take ampethamines long term?  My answer is easy – definitely NOT.

Another drug, Strattera, marketed as the first non-stimulant ADHD medication causes liver damage. The USFDA warned that severe liver damage may progress to liver failure resulting in death or the need for a liver transplant in a small percentage of patients taking Strattera. The labeling also notes that the number of actual cases of severe liver damage is unknown because of under-reporting of post-marketing adverse events.

Should children or adults with ADHD take Stattera long term?  My answer is easy – definitely NOT.

[i] Feb 9 2005 OTTAWA - Health Canada instructed Shire BioChem Inc., the manufacturer of ADDERALL XR® to withdraw the drug from the Canadian market. Health Canada has suspended the market authorization of the product due to safety information concerning the association of sudden deaths, heart-related deaths, and strokes in children and adults taking usual recommended doses of ADDERALL® and ADDERALL XR®. The immediate release form of ADDERALL® has never been marketed in Canada. Health Canada is advising patients who are currently being treated with ADDERALL XR® to consult their physician immediately about use of the drug and selecting treatment alternatives. Health Canada's decision comes as a result of a thorough review of safety information provided by the manufacturer, which indicated there were 20 international reports of sudden death in patients taking either ADDERALL® (sold in the United States, not in Canada) or ADDERALL XR® (sold in Canada). These deaths were not associated with overdose, misuse or abuse. Fourteen deaths occurred in children, and six deaths in adults. There were 12 reports of stroke, two of which occurred in children. None of the reported deaths or strokes occurred in Canada. A preliminary review of safety data for the other related stimulants authorized for use in the treatment of ADHD in Canada has been conducted. In that review, the incidence of serious adverse reactions leading to death was higher in ADDERALL® and ADDERALL RX combined than in the other drugs of this class

Children's Health  Stephen Gislason MD  Revised Jan. 2015