Ritalin Side-Effects Explained//Parents "Caught in the Middle"
Derek A. Wholeflaffer A.S.A.
If there's one image that has been used to illustrate the Ritalin
controversy, it's that of a line of elementary schoolchildren waiting at
the nurse's office at midday to receive their daily medication. The
image has been pervasive in the media for more than a decade but has
been popping up with increasing frequency in the past year or two,
particularly on television news, talk, and magazine shows.
The context into which these troubling questions and images fall
is not always reassuring. The use of psychotropic drugs as quick fixes
for complicated problems has been tried before--with results that
indicate mixed benefits and with problems that accrue over years and
require a long-term perspective to appreciate. How many American women
(and men), for instance, took the tranquilizer Valium, feeling the need
to blunt the edges of their jagged lives, only to discover later that
they were involved with a highly addictive drug? And a generation
later, similar questions are being raised about the antidepressant
Prozac--can a feel-good drug really make you feel good without exacting
a price?
The Ritalin debate, first spurred in the mid-1980's by attacks on
the drug from the church of Scientology, has often been rancorous. Even
as the scientific and medical establishment continues to build a
convincing case for the efficacy of Ritalin, with only minimal side
effects, media attention jangles a noisy counterpoint. The national
support organization Children and Adults with ADD (CHADD) is often
accused of being in financial cahoots with Ciba Pharmaceuticals, the
company that manufactures Ritalin, to promote the drug. Educators are
faulted for preferring chemical intervention over more difficult and
creative attempts to tailor teaching to a child's individual needs. And
if Ritalin works to adjust the world of disordered children, can it not
also boost the performance of "normal" children? Increasing evidence
and anecdotes say yes. While it was once thought that non-ADD children
did not respond top MPH, studies by NIMH's Judith Rapoport, M.D., and
others have determined that this is not the case. Non-ADD children
experience the benefits of a similar sharpening of focus when they take
Ritalin. In fact, more and more teens are using what they call "vitamin
R" or the "smart drug" recreationally and reporting energy bursts and
euphoria after crushing and snorting the pills they either steal from
their younger siblings or buy from children for whom they have been
prescribed.
Ritalin as a drug of abuse is a relatively recent phenomenon, and
one that is fueling the general debate over the medication. The Drug
Enforcement Administration (DEA) recently released preliminary findings
that bash a petition by CHADD and the American Academy of Neurology to
ease controls on prescribing MPH; the potential for abuse is the main
reason given. Even the United Nations has gotten into the act, in the
form of a recent report from its International Narcotics Control Board
that urges "all governments to exercise the utmost vigilance" to prevent
overdiagnsosis of ADD and "medically unjustifiable" treatment with MPH.
Caught in the middle are parents, who almost always struggle with
the decision to medicate their children, and the children themselves,
who, depending on their age, may or may not understand why the pills
they take seem to make life so much better.
About one fact there is no question. Statistics show a dramatic
increase in the use of Ritalin in recent years. More and more Ritalin
is being dispensed every year in this country, and the bulk of it is
prescribed to children.
The DEA classifies methylphenidate as a Schedule II drug, meaning
that it has a currently accepted medical use by a high potential for
abuse, which may lead to SEVERE psychological or physical dependence.
Schedule II regulations prohibit prescription refills and call-in
prescriptions and impose aggregate production quotas. From the
mid-1980's until 1990, the quotas rose slowly, with a couple of downward
blips. From 1990 until a slight leveling-off in 1996, production quotas
climbed relentlessly.
Methylphenidate is also used to treat narcolepsy in adults and
increasingly to treat adult ADD, but by far the most common use is for
children with ADD. According to the "Textbook of Pharmacotherapy for
Child and Adolescent Psychiatric Disorders (1994), nearly 2 percent of
school-age children--more than 600,000 children a year--receive
stimulant medication for ADD symptoms. Methylpyhenidate is not the only
drug used for ADD, but it is the most common. Dexedrine
(dextroamphetamine) and Cylert (pemoline) have been found to confer many
of the same benefits as Ritalin and are effective for some children who
do not respond to Ritalin, but they have their own problems.
Amphetamines have the reputation of being highly prone to abuse and may
be difficult to get in some area, and Cylert has been associated with
possible liver damage.
There is agreement among practitioners, among critics, and within
the DEA that there are two reasons for the steady rise in methyplenidate
quotas: the increasing number of ADD diagnoses and the widespread
acceptance by the medical community that methylphenidate is an effective
treatment. It is an acceptance based on EMPIRICAL scientific data:
Reviews of the thousands of studies that have been done on the efficacy
of methylphenidate in treating the symptoms of ADD final success rates
averaging about 75 percent, although there is NO evidence of continuing
relief of symptoms once the drug is discontinued.
Re: Parents Caught in the Middle Over Ritalin Side-Effects (Response)
From: tim...@minn.net (Tim McNamara)
> "Art Wholeflaffer <smq...@cyberhighway.net> wrote:
> There is agreement among practitioners, among critics, and within
> the DEA that there are two reasons for the steady rise in methyplenidate
> quotas: the increasing number of ADD diagnoses and the widespread
> acceptance by the medical community that methylphenidate is an effective
> treatment.
To my mind, the primary question isn't whether Ritalin is effective (the
evidence seems to be that it is, not only for ADD but also as an
alternative therapy for depression- especially post-CVA) but whether ADD
is being over-diagnosed. In other words, are kids being tagged as ADD
when in fact the real problem is the home environment, social environment,
school environment, nutritional, relationships, needing glasses, other
problems such as a central auditory processing disorder, etc.?
This is the part of the debate that is currently raging, I think, not the
medical efficacy of Ritalin. (At least, that's the focus of the Ritalin
controversy in my neck of the woods).
Tim