{"id":190,"date":"2009-10-15T00:00:38","date_gmt":"2009-10-15T07:00:38","guid":{"rendered":"http:\/\/blog.stevenreidbordmd.com\/?p=190"},"modified":"2009-10-15T07:14:06","modified_gmt":"2009-10-15T14:14:06","slug":"politics-religion-and-adhd-meds","status":"publish","type":"post","link":"http:\/\/blog.stevenreidbordmd.com\/?p=190","title":{"rendered":"Politics, religion, and ADHD meds"},"content":{"rendered":"

\"pills2\"Cross-posted from Technorati<\/a> with permission.<\/i><\/p>\n

At a dinner meeting a couple of weeks ago I met two psychiatrists who work at Kaiser Permanente, the large HMO system that boasts a 24% health insurance market share<\/a> in California. \u00a0(This has nothing to do with my story really. \u00a0I just think it’s amazing that a quarter of all insured Californians are Kaiser patients.) \u00a0As we described our practices, I mentioned that I recently helped a patient stop his\u00a0Adderall<\/a>,\u00a0the amphetamine combination drug given for Attention Deficit Hyperactivity Disorder or ADHD. \u00a0The patient had come to me on a very high dose and was complaining of many side-effects: anxiety, muscle twitching, severe insomnia, weight loss. \u00a0I gradually tapered and eventually discontinued the stimulant over several weeks, with resolution of most of these symptoms. \u00a0He thanked me and said he felt much better. \u00a0I related this story with some pride, and mentioned to my dinner companions that I’ve had more success stopping<\/em> high-dose medication, especially for ADHD, than I’ve had starting<\/em> ADHD medication. \u00a0Moreover, I opined that ADHD is too readily diagnosed in adults, resulting in a lot of unnecessary amphetamine being prescribed.<\/p>\n

I had not anticipated how odd these statements sounded coming from a psychiatrist. \u00a0One of the Kaiser docs, a child psychiatrist, quickly noted how many kids she’d helped by identifying and treating their ADHD. \u00a0It’s an under-recognized problem, she assured me. \u00a0The other psychiatrist only saw adults, yet he too underscored how Adderall, Ritalin<\/a>, and other stimulants helped his patients. \u00a0Someone mercifully changed the subject, and we let the matter drop.<\/p>\n

It got me thinking though. \u00a0First, could we all be correct? \u00a0I have no reason to doubt the experience of child psychiatrists who see their young patients perform better, achieve more, and get along better with others when treated for ADHD. \u00a0I don’t see children myself, and am basically a bystander in the debates<\/a> over<\/a> medicating<\/a> children for ADHD and behavioral problems. \u00a0Moreover, even in adult psychiatry I believe that prescribed stimulants can sometimes help, not only for ADHD but also for depression in the severely medically ill, and in some other situations.<\/p>\n

But my own experience has led me to be cautious. \u00a0“Adult ADHD” is a fad. \u00a0Its rate of diagnosis and treatment have skyrocketed<\/a> in recent years, for no good scientific reason. \u00a0I get calls all the time from people who have diagnosed themselves using a simple online checklist<\/a> and are seeking an MD to rubber-stamp<\/a> an amphetamine prescription. \u00a0Since amphetamines are performance-enhancing even in normals<\/a> and have street<\/a> value<\/a> as drugs of abuse, these potential patients put me in the uncomfortable position of second-guessing their request. \u00a0I’m not saying adult ADHD doesn’t exist \u2014 in fact, I’m sure it does \u2014 but this isn’t the kind of relationship I want with patients. \u00a0So I tell callers I don’t do ADHD evaluations, leaving me with lingering regrets about thwarting the subset \u2014 I don’t know how big it is \u2014 who have a legitimate need for this treatment.<\/p>\n

And frankly, I’ve seen these medications over- or mis-prescribed by my fellow psychiatrists on a number of occasions. \u00a0In addition to the patient mentioned above, for nearly a decade I’ve seen a distinguished senior academic for medication treatment of anxiety and depression. \u00a0He’s never had an ADHD diagnosis. \u00a0Nonetheless, he asked his psychiatrist back in 1993 to add Ritalin because a relative with ADHD benefited by it. \u00a0He’s been on it ever since, 16 years. \u00a0I tapered the dose down by more than half, but my patient resists using less, even though it likely worsens his anxiety and he needs medication for sleep. \u00a0At this point I expect he’s on it for life. \u00a0Another patient of mine, a young woman without an ADHD diagnosis but with a history of anorexia, had been prescribed 40 mg of Ritalin daily by her prior psychiatrist. \u00a0It helped her concentrate, but also suppressed her appetite, which was a major psychological issue for her. \u00a0We tapered down the Ritalin and discontinued it over about a year and a half, at which point she was doing well and reconciling with her mother \u2014 who, my patient said, had abused Ritalin herself for a long time.<\/p>\n

Well, you get the idea. \u00a0I’m not opposed to psychostimulants, honest. \u00a0And I do believe ADHD is a serious problem and that it responds well to medication, along with other treatment. \u00a0However, I also believe that, in adults anyway, inattention and hyperactivity can mean lots of things. \u00a0I believe stimulant medications that cause anxiety, insomnia, loss of appetite, teeth grinding, high blood pressure, and other side-effects ought to be used judiciously. \u00a0(And I also believe that a patient needs to have had symptoms by age 7<\/a> to fulfill DSM-IV diagnostic criteria for ADHD.)<\/p>\n

Some of the most contentious, polarized arguments in psychiatry revolve around ADHD and its treatment. \u00a0Are we poisoning our children with stimulants? \u00a0Or leaving thousands to suffer unnecessarily? \u00a0So far, these arguments still generate more heat than light. \u00a0 The main thing I learned at the dinner meeting I attended is that, like politics and religion, ADHD and its treatment remains a touchy topic in polite conversation.<\/p>\n","protected":false},"excerpt":{"rendered":"

Cross-posted from Technorati with permission.<\/p>\n

At a dinner meeting a couple of weeks ago I met two psychiatrists who work at Kaiser Permanente, the large HMO system that boasts a 24% health insurance market share in California. (This has nothing to do with my story really. I just think it’s amazing that a quarter of […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[6,7],"tags":[26,27,29],"class_list":["post-190","post","type-post","status-publish","format-standard","hentry","category-medication","category-psychiatric-diagnosis","tag-adhd","tag-stimulants","tag-technorati","odd"],"aioseo_notices":[],"_links":{"self":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/190","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=190"}],"version-history":[{"count":16,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/190\/revisions"}],"predecessor-version":[{"id":223,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/190\/revisions\/223"}],"wp:attachment":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=190"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=190"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=190"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}