I posted this in a HN thread about therapeutic uses of nicotine a week ago, but it's even more relevant here:
> A friend of mine is a psychiatrist who specializes in treating ADHD. She told me about a conference she went to recently, where someone presented an interesting paper.
> Apparently, there was an amazing study done relatively recently (last five years), in which they demonstrated that, in mice, exposure to nicotine during pregnancy results in higher rates of ADHD in the grandchildren (passed down through the female offspring exposed to nicotine in utero, not the males).
As with any study conducted on animals and not humans, there's an asterisk next to it, but these findings would be monumentally significant for understanding ADHD.
Separately, I've never understood why Adderall isn't approved for use in Europe (or, futhermore, why Vyvanse should be approved, if Adderall isn't - Vyvanse is just a more concentrated version of the d-enantiomer, making it more effective[0] and reducing the side-effects).
On an unrelated note, it looks like the copy editing on the article was a bit off. Concerta is a long-acting drug, just like Vyvanse (the article makes it seem like it isn't). Also, I'm not sure what to make of the sentence "The U.S. still dwarfs Europe in sales of ADHD drugs, but the rest of the world has been catching up."
[0] It's actually less effective by weight than Adderall XR, but that's because the mechanism it uses for the extended release is very different.
EDIT: It's interesting watching all six of the comments on here (not counting losethos's) get upvoted and downvoted in roughly equal proportions. Clearly this is a controversial topic on here; I only wish the those upvoting/downvoting would join in the discussion.
Nothing at all. Methamphetamine, which is not very different than the dextroamphetamine in Adderal, has proven to be a remarkably safe substance and in general, society benefits a great deal when people ingest methamphetamine. I'm sure schoolchildren being prescribed dextroamphetamine to take every single day for years is a very good idea as well.
I don't think it's reasonable to compare the effects of street methamphetamine (which is most likely not pure and the dose is not regulated) with the effects of therapeutical doses of dextroamphetamine prescribed by a doctor.
Are you honestly comparing crystal meth from the street to something prescribed under the guidance of one's doctor? Your post strikes me more along the lines of hysterics than a rational foray into discussion.
For shits and giggles, let's compare apples to apples. Desoxyn (Methamphetamine HCl). There you get the scary M word, but one that's FDA-approved and prescribed--though, admittedly, not commonly--by doctors. Same chemical substance minus the crystallized form, impurities, and of course, the world of illicit meth.
Oddly enough, Abbott Pharmaceuticals isn't synthesizing Desoxyn in their backyard meth lab ala shake-and-bake and Walgreen's isn't hawking it from the saddle bag of their pharmacists' motorcycles. Same substance, different context.
If you want to argue against possible long-term effects of d-amphetamine on developing children, do so. You certainly won't be alone, though for all the hysterics and despite thousands of long-term studies on its effects, there's a rather glaring dearth of support for that position. But, hey, "methamphetamine!"
I am absolutely comparing dextroamphetamine to methamphetamine. It doesn't matter by whom it was synthesized.
They are very similar in pharmacology, so you'd be deluded to not compare the two. Same addictive properties, same deleterious effects on health, similar abuse potential.
And yet, different contexts lead to vastly different results. One is prescribed under a doctor's guidance at therapeutic doses and administered orally; the other is smoked, at [i]significantly[/i] higher dosages, to speed up absorption with much higher concentration levels accumulating directly in the brain.
In other words, your argument is inherently simplistic and purposely misleading. Despite similarities in structure, the pharmacodynamics differences between therapeutic usage of Adderall and illicit meth are significant. When you gloss over the differences, you're radically undermining your position. My point with Desoxyn, which you completely ignored, rebuts your position even more clearly.
Most medications have the potential for hazardous effects higher up the dose-response curve. That potential, however, doesn't magically negate clinical effects lower on the curve. A little is good, a lot (or with acetaminophen for instance, a little more) can be deadly. That's nothing new. Just as with potential for side effects, you and your doctor work to manage it during treatment.
On another note, when you raise the specter of crystal meth usage, you aren't just isolating it to matters of pharmacology. Especially when you're talking about usage externalities and societal benefits: the external costs associated with manufacture and distribution all come along as mental baggage with the words "crystal meth." Your hysterics purposely ignore this in order to make the comparison seem more damning on a purely emotional level.
The reason I appeal to sets of things is because I find it completely ridiculous that children are routinely prescribed this dangerous stimulant drug for what I consider very flimsy reasons.
Most people don't really realize what Adderall is, and American society as a whole seems to assume that doctors and pharmaceutical companies know what they are doing and are trustworthy, despite many indications to the contrary.
The pharmacology of "illicit meth" is no different than the pharmacology of legal methamphetamine, other than some contamination. The pharmacology of dextroamphetamine is not so different either, mainly it comes on slightly more slowly and lasts less time.
The reason that crystal meth usage is so bad for society is because the drug is truly terrible for you. I am well aware of everything you said, and I disagree that "just a little bit of amphetamines" is helpful for kids to be receiving for ADD.
I'm confident that history will see me out on this. If you want to give your children speed, have fun.
Methamphetamine in fact IS prescribed by doctors to treat certain disorders. It's unfair to compare prescription methamphetamine to street meth since street meth is not only often very impure, but is typically taken in dosages 30x - 50x greater than a therapeutic dose.
This logic could also be used to argue that acetaminophen / ibuprofen should be Schedule I narcotics since taking a dose 30x - 50x larger than the therapeutic dose would almost certainly result in death.
Anyone who took a dosage 30-50 higher times the prescribed dosage of methamphetamine would quickly die. The impurities are irrelevant: the drug is toxic even at normal doses.
I disagree with your comparison of acetaminophen and amphetamines. It seems to be based on your deluded idea about dosage, but other than that, the drugs differ in some rather significant ways such as abuse potential, habituation, psychoactivity, and so forth.
A therapeutic dosage of methamphetamine (Desoxyn) is about 5mg - 15mg, whereas a recreational dosage can be as high as several hundred milligrams. Though certainly toxic at higher doses, research hasn't shown that the drug is toxic at therapeutic levels. Like the majority of drugs, doctors must balance its benefits with any potential side effects.
You can disagree with my comparison if you'd like, but the fact remains. Don't take my word for it - I encourage you to read some of the research out there surrounding therapeutic methamphetamine as well as the more common levo/detroamphetamine.
I'm sure all the pharmaceutical corporations would love to have me hooked on their methamphetamine, and the history of these companies and the way they have taken advantage of and poison of the American public should be well known by now.
Amphetamines are highly addictive. They require perpetually higher doses to maintain the same activity in the body, like most other highly addictive substances. I'm sure there are some legitimate therapeutic usages for these drugs (narcolepsy). However, I see them as massively over prescribed to people who do not actually require them.
If you are not treating a child with severe or even moderate ADHD with Amphetamines, the risks are severe and not so rare at all.
Almost by guarantee the child will not achieve remotely as well as it could. Both in school and within social groups. Both of these failures will almost by guarantee lead to further problems down the road.
It has been shown that untreated ADHD multiplies the risk for other very real disorders, like bipolar disorder for example.
I disagree, and I'm confident sane history will eventually look back in horror at the idiots giving their kids amphetamines willy-nilly.
Perhaps some children need this. The vast majority receiving these drugs would benefit a lot more from realistic parenting and school situations than from a toxic, addictive stimulant pill.
Those enlightened future beings will have to discover some theoretical side effects which justify the obvious disadvantages of denying treatment and just haven't been seen yet despite of decades of experience with these drugs.
These side effects need to be severe, given the massive amount of consequences of untreated ADHD.
There is a very good MOOC on ADHD from coursera, the videos should still be up. I don't think anyone who has a low to medium understanding of the topic can claim that ADHD does not exist. The evidence for the existence is compelling and overwhelming.
A short non-exhaustive summary: visible symptoms, effects on specific cognitive tests, reversal of symptoms under treatment, significant changes in neuroanatomy and brain activity in MRI, differences in EEG spectra and severe consequences like lower Income, higher propensity for violence and addictive behavior plus a markedly worse social life.
The thing is that I'm more likely to believe its a combination of environmental toxins, food poisons such as artificial coloring and preservatives and incomplete parenting than something that could be treated effectively with more chemicals.
My mother was only just recently diagnosed with ADD (After having 2 out of her 5 children with the same ADD/ADHD diagnosis). This was AFTER dealing with depression and various diagnoses including bipolar. She is in therapy to not only manage her ADD, but also deal with all the issues as a result of a lifetime of unmanaged ADD. I have ADD, but was diagnosed young, I learned how to manage and only went on meds when I was mid 20's since my non medical management didn't work well outside a structured school setting (and barely did in highschool/college). My depression and anxiety are made worse if not caused by ADD and has affect social and work life (good and bad). While I agree that ADD/ADHD can be overdiagnosed and even possibly overmedicated, I agree that not having a diagnosis can cause a worse life than otherwise.
First off, I recommend you ask a licensed professional that type of question.
My experience being switched from Adderall XR to Vyvanse a few years ago when it first came to market in the U.S. has been positive. Vyvanse seems less addictive (missing a week or two between prescriptions is not a big deal) or prone to side effects like insomnia.
This was my experience as well. After 6 months on adderall I had already shown signs of addiction (dosage was needing an increase in order to maintain its effectiveness). I have been on the same dosage of Vyvanse for 4 years now, without any problems.
It isn't addictive for everyone; a good thing for me insofar as having my supply stolen by people who are addicted or want to resell it causes me only financial rather than chemical distress.
> "Vyvanse is just a more concentrated version of the d-enantiomer"
Not at all; it's a prodrug that is converted into the d-enantiomer by your liver, at whatever your xenobiotic-metabolic speed is.
The major result of this has nothing to do with how safe a regular pill-dose of Vyvanse is vs. Adderall (or, equivalently, Strattera vs. Ritalin.) Instead, the effect is that you can't convert Vyvanse into an injectable or smokable form to make it absorb faster. There's no simple physical process you can put prodrugs through to turn them into something that will get you high; they need the full biological environment of your liver to be "unlocked", and it will only do so at a rate safe for you. (Or it'll create cytotoxins if you overload it, but this still won't get you high.)
And because of this, it's much safer statistically to prescribe it; with Adderall/Ritalin, there is a high chance that any voluntary self-diagnosed case will turn out to be a junkie/drug-seeker/drug-seller. With Vyvanse/Strattera, that potential for "malicious use" doesn't exist[1]. There are still all the same medical dangers, to be judged by doctors on an individual basis -- but there's a far lower worst-case downside in prescription.
(Further, prodrugs aren't addictive when taken at recommended dosages, since addiction is [likely] caused by your brain correlating spikes in its chemistry with recent memories, and prodrugs aren't "spiky" in the way their raw agonist or reuptake-inhibitor forms are.)
---
[1] Well, it does, but only in the nootropic/"study drug" market; not on the street.
> There's no simple physical process you can put prodrugs through to turn them into something that will get you high;
The fact that Vyvanse is a prodrug is emphasized heavily in its marketing, but the anti-abuse potential is overstated, IMHO. Even some very cursory searching on Bluelight, et. al. will yield a dozen ways to either magnify or dampen the effects of Vyvanse using common foods, etc.
> with Adderall/Ritalin, there is a high chance that any voluntary self-diagnosed case will turn out to be a junkie/drug-seeker/drug-seller.
Well, we can't prescribe any psychiatric medication, addictive or not, to people who are "self-diagnosed".
> Well, we can't prescribe any psychiatric medication, addictive or not, to people who are "self-diagnosed".
I meant "self-diagnosed" as in "books an appointment with a therapist because they think they have X, whereupon the therapist tests them for X, and then sends them to a psychiatrist who tests them more carefully for X and, finding that they do have X, prescribes them medication for X."
Junkies can and do game this by looking up the tests online (which are, if you didn't know, just battery self-assessments of correlated behaviors.) But the only way to prevent this (besides coming up with objective measures for ADHD involving fMRI scans, like they've done for depression) would be to only prescribe neuroaffective medications to people whose lives take such a bad turn that they end up talking to a psychiatrist involuntarily (i.e. in a mental ward), thus preventing anyone who is self-aware-enough to notice that they have a problem from solving it.
How exactly is it supposed to work then? People don't recognize the symptoms of mental disorders in themselves or others. Sure, you can tell if someone is having an extreme psychotic episode, or an extreme depression. In less extreme cases outwardly "harmless" symptoms of depression or ADHD are wrecking people's lives.
The potential abuse of the system does not mean it doesn't do more good than harm.
> “There’s been a great deal of resistance to even believing there is a disease,” said Mary Baker, president of the European Brain Council, a Brussels-based non-profit representing doctors, patients and companies including Shire that work on neurology and psychiatry issues.
If I read the description of the wikipedia article, I could easily think that I suffer from ADHD. To me it feels a little bit like asperger syndrome where you can pick and choose related syndrome and believe you might suffer from it when you are just a little bit asocial. To exaggerate, it is like reading an horoscope and thinking that, woah, it is exactly how you are or how this person is.
Obviously there are trained doctors and psychiatrist and whoever who can judge whether or not a kid suffer from adhd but it seems that it will be way more than 7% of kid that could get bored by tasks they are being test for and that is why adhd seen from outside the usa feels too often diagnosed.
Others have said how the drug would have helped themselves or is helping themselves but has it been shown that the drug would not help everyone who takes it to focus and perform better at test and studying or working.
Since I live in the USA, I have asked the questions to college student and it seems a fairly common thing to take a pill before exam to get that extra edge for focus (granted you don't start cleaning your apartment and become very thorough while doing it).
Even if the drug could help some people, it is not unreasonable to consider whether introducing the drug to society has an overall benefit and not just a benefit to the company selling it. France has already a problem with to many prescriptions of anti depressor drugs so maybe it is not a good idea to jump on adhd pills.
- Not able to drive unless taken medication since every sign, pedestrian, other cars and movement keeps you from paying attention to what is in front of you (including lights, cars and pedestrians). (Like running into a tree since you were trying to admire the forest and not paying attention to where you were going).
-Stopping mid sentence/conversation to finish a sentence/conversation (whether or not with the same person) that may have happened weeks or years ago.
-Being verbally told something, and remembering it until someone else tells you something/asks for something or you see something else 'shiney'.
-Finishing someone else's sentences due to them being too slow to finish it (whether or not what I say is correct)
-Having many projects half finished- not necessarily since I got bored with them, but it took to long to finish and something else more shiney/important happened.
-Finishing a book 4 years later, always knowing where in the plot you are and what is going on, but not finishing because another book wanted to be read first.
-Saying/writing a sentence wrong since you try to say the same thing 2-3 different ways ALL AT ONCE. Also works trying to move 2-3 different directions all at once.
ADHD is defiantly a real thing, but I don't think we should drug it out of them. We should make sure they go into suitable jobs/schools, where adhd would have advantages as opposed to disadvantages.
Why not "drug it out of them"? If the disease is caused by a chemical imbalance, why not try to fix the chemical imbalance? Some people (myself included) are not functional without medication.
Personally, I'm pretty skeptical that most of the people diagnosed with it have a disease. I think it's a perfectly normal human variation that just doesn't match well with our Industrial Age approach to education.
The way I think of it is like height. There's a normal range of tall and short. There are also diseases that make people unusually tall or short. But mere shortness doesn't prove disease. And just because short people have trouble reaching cabinets built for average people doesn't mean we must give short kids extra hormones to make them be average in height.
I think it's reasonable to say, "Hey, in the world we want to create, it's better if many or all people take drugs to shape behaviors so that they match the system they should fit into." Why I don't like is the medicalization of variation.
I think it is perfectly reasonable to take that viewpoint. It certainly might be over-diagnosed. However, as with all neurological disorders, there is often quite a bit of mutability in the actual diagnosis; It isn't uncommon for people to be initially diagnosed with ADHD, only to be later diagnosed with something else. There are a lot of overlapping symptoms with other disorders, varying from OCD to Bi-Polar to Asperger.
Sure. And that's a sign to me that we don't really understand what's going on yet.
Those are interesting to mention in this context. It's a commonplace among hackers that a little OCD or a little Asperger can be beneficial in some circumstances. Indeed, Temple Grandin, perhaps the world's best-known high-functioning autistic, recommends computer programming as a career for people like her. Among artists, the same is true about Bipolar (the book Touched with Fire is an interesting study of why and how that's true).
I think it's relevant that Asperger was a valid diagnosis for a few decades, but it no longer is. (As of DSM-5, people are just placed somewhere on a spectrum of autism.) That's a great sign that we still have a lot to learn.
I'm sure you get this, but I worry that others will misunderstand me, so let me be clear here: I'm not saying that any of these things aren't a problem for people in today's society.
With attention span, for example, high-end classroom-style education and many high-end jobs require a great deal of focus. But that doesn't imply that people with lower-than-average levels of focus are diseased. Indeed, more than half of Americans consume stimulants daily, and many workplaces provide their staff with free stimulants (coffee, Coke) so they can keep up. Many unarguably normal students consume ADHD meds as study aids. If stimulants improve performance for everybody, they can't be considered diagnostic for a problem.
My concern here isn't that people are choosing that. We're half-evolved monkeys; it's great that we can choose who we want to be. My concern is that we're taking natural human variation and medicalizing it mainly because our current educational system finds some of that variation inconvenient.
People with ADHD have reduced brain growth in areas associated with executive control.
ADHD is very real. So is the 50%+ of untreated people with ADHD having substance abuse problems. So is the higher suicide rate. So is the reduced rate of high school and college graduation. So are the dramatically increased rates of depression. Then there is the incredibly high rate of co-morbidity of ADHD with other psychological disorders, most prominently Bipolar Disorder.
Those are interesting facts, but I don't think they prove anything about existence of ADHD as an actual disease. Lower-than-average height is also correlated with many diseases but it isn't a disease on its own.
The portion of the brain associated with self control is smaller in people with a mental disorder that is characterized by a lack of self control.
Now obviously proving the entire causation thing here is pretty hard, but, if someone is missing their eyes, and that person is blind, there might just be a causative relationship happening.
(The % is higher in the untreated population, no citation on hand right now sorry)
Over 50% of people with ADHD have substance abuse problems.
Imagine taking a population and saying "oh yeah half those people are alcoholics, but there is no strange underlying cause, nope, we should just let them be."[1]
ADHD isn't the popularized image of "little Johnny can't do his boring old homework that the mean teacher assigned", but rather "Jenny can't make herself go to sleep even though if she is late one more day for work she will be fired and have no money for food or rent."
ADHD is like having your entire sense of self control ripped away from you, no matter how much you want to do something, you cannot force yourself to do it. Pleading and begging doesn't work. Breaking down in tears over one's complete lack of ability to accomplish the simplest of tasks doesn't help any. The neurochemical responsible for self control quite literally isn't there.
[1] Well ignoring that America has basically done that for multiple cultures already...
I'm not our society is structured such that in many common circumstances, greater linearity is beneficial. I'm also not denying that there could be relationships between size of brain regions and various physical characteristics. And I'm certainly not denying your experiences.
What I'm questioning is constructing this as a mental disorder.
That's distinct from, say, psychosis. 100k years ago, being totally delusional would have been harmful. But there's no reason to think that most people classified as ADHD would have been at any disadvantage.
Again, come back to the height analogy (which you haven't addressed so far). There are obvious advantages in our society to being taller, including greater career success. Many short people hate being short. Does that mean there's something wrong with short people, or that they should all be treated with drugs as soon as we can diagnose Tallness Deficit Disorder?
Actually below a minimum height, treatment options are given to parents to help their children grow taller. There is a well estab
I also feel that you are tending towards the naturalist fallacy here. Just because something is natural doesn't mean that it is good (or neutral). Mother nature doesn't care.
As for ADHD existing 100k years ago, a large percentage of ADHD cases are in children born to mother's who used drugs during pregnancy. (Obviously not all, but there is a very large %). One cannot discount at least some modern factors being responsible for some percentage of ADHD cases.
And yet, thousands of doctors do, and they prescribe medication to thousands of patients who also do, and for the most part, those medications work as expected.
Vyvanse is a prodrug of dextroamphetamine, which means that it turns into that in the body. The advantage allegedly is that it's less prone to abuse but the real reason it exists is that dextroamphetamine entered the market in 1937 and so its patent has long since run out. Dextroamphetamine in turn is just amphetamine with the left-handed isomer removed. This left-handed isomer is less potent than the right, but both promote higher concentrations in the brain of the same chemicals norepinephrine and dopamine.
Amphetamine you may know better under its colloquial name -- speed. That's right, Shire Pharmaceticals is upset that European doctors and parents aren't rushing to give children fancy, expensive, speed.
I'd think Speed would have helped mothers more than Valium, but my mom used to say that she and her neighbors just had martinis instead, and a Valium's just a much stronger version of a martini. Ah- the 60's.
And heroin (with a few chemical bit twiddles) is used to treat pain after major surgeries and accidents. And methamphetamine (with a few chemical bit twiddles) is used to treat stuffy noses. Face it, almost all drugs can be misused...but that is not a reason for them to be banned.
After 8 years and 3 dropouts into my 4 year undergrad degree, I was finally diagnosed with ADHD. My pre-diagnosis GPA was 1.9, my post-diagnosis GPA was 3.9. I graduated less than two years later, and within 3 years I was earning a 6-figure income and providing for a wife and newborn child. I would likely be a divorced, homeless, deadbeat dad without Vyvanse (or its similarly Amphetamine-derived Adderall).
Don't take my life away from me, and don't take it away from anyone else, just because you have a fucking delusional conspiracy theory that a drug company is trying to addict kids to speed.
I only know of one non-stimulant alternative (strattera), and it didn't work for me (it handled the ADHD to some degree, but the side-effects were terrible). They definitely could use a little more progress in that area, as I would love to stop using Amphetamine derivatives.
You do sometimes see wellbutrin as an off-label use.
I'm also curious which side-effect you experience from strattera. In my mid-20's, I moved off amphetamines onto it, and have had no side-effects at all.
There is essentially no progress in this area because nobody cares. They keep finding new amphetamine derivatives to make, and they are quite cheap to produce, and still patentable.
Medicine in the form of antibiotics and inoculations against various dangerous diseases has brought us far, but it seems to be time to rethink some of the recent developments.
Maybe we can stop growing a monoculture of humans where the slightest deviation from the norm must be treated with some kind of drug.
I am from Europe (but live in the US) and I salute the folks there resisting this nonsense. (And for the record I am not saying there do not exist cases where treatment with such drugs would be indicated, just that the extend to which this is done in the US is not healthy).
I'd recommend that you talk to a few people with ADHD and see if they consider their disorder to be "the slightest deviation from the norm". It's clear from this article that doctors certainly don't see it that way.
And I'd recommend you visit the overflowing offices of a few shrinks scamming patients by charging $100-$150 for five minute appointments to provide the monthly refill for adderall.
I don't think that anecdotes, personal beliefs, or unqualified claims are the right way to approach something like this, especially if you don't have any personal or professional experience with the disorder.
Any disorder or disease that requires a potentially addictive medication will inevitably have crooked doctors - this is seen as well with patients requiring Morphine or Codeine. This crookedness is a separate issue from the illness, and is not relevant in a discussion about neurobiology.
In the UK, I didn't have to pay anything for refills of concerta. In NZ, I only had to pay the GP who gave me a referral to a free psychiatrist for methylphenidate and dexamphetamine sulphate.
In both places, it has been a relatively long journey to get medication. They were keen to try to resolve my issues without drugs - it was about half a year between when I started seeing a psychiatrist and when they suggested medication.
As an adult with ADHD, I can agree. It's definitely real, and it's definitely not just something that can be easily ignored without proper education about it (And without proper medication if necessary).
Personally, I was lucky, as I was diagnosed as a younger age (Around 5th grade or 6th grade). Recently I took a college course on handling ADHD in college, and my professor also had ADHD, having had it for many years, struggling with it, and not ever learning about it until she was around 50 years-old.
I agree with those who say it may be over-diagnosed, but at the same time, it's frustrating to see people who have no understanding of the disease at all tell me that it's all in my head and I should just get over it and act like everyone else. Being a bit older, I've learned to simply shake it off and move on, but it tough being a kid struggling to do stuff that others seem to be able to accomplish no problem, and then be told that you're simply not trying hard enough and never get any access to education on ADHD and/or medication. It's no different then going up to someone with depression and telling them it's all in their head and to just stop it. It simply doesn't work that way, and pretending it does only makes those with the disease feel worse about themselves without helping them.
thanks to uninformed attitudes like yours, I was unable to get any treatment for my ADHD for years while living in Europe. Instead I was told that I was stressed because I was depressed, and depressed because I was stressed, and made to feel like it was my fault for not being easily treatable.
Maybe we can stop growing a monoculture of humans where the slightest deviation from the norm must be treated with some kind of drug.
Yes, yes, and vaccines are a pharmaceutical industry plot, and all the rest. I am really tired of this amateur-hour analysis from people who can't even be bothered to muster up a citation for their hand-waving argument.
Go anywhere outside of the US and Europe and they would laugh at you. Our culture (hispanic) takes it as a sign of weakness and petty complaints. Most people are too worried trying to feed themselves or their families to even think about being depressed. Furthermore, with the little money they have they tend to go to doctors for diseases that directly affect their bodies or ability to earn.
What you should think about is that for one person like yours that stays untreated with your ADHD, in the US there might be a lot of kids forced to undergo treatments for what is no real ADHD. I grew up in Europe, and I seriously think that I would have spent my life under a very high amount of drugs if I had been raised in the US.
I'm very glad I didn't have to go through this, because in Europe it is much more difficult to be recognized as someone having ADHD.
So I'm sorry for you to have suffered, but I can't say I'm not happy I didn't.
All of this said, I no I have no data to back this up, it's just a gut feeling.
Of the two attitudes, only one ensures that those who do suffer from ADHD aren't able to receive treatment. Misdiagnosis, when it occurs, is able to be handled on a case-by-case basis; the "no such thing" stigmatization and other similar lines of reasoning, on the other hand, are a priori positions that reinforce biases that actively work against those who are seeking treatment and those who should but aren't, and as a result, directly contributes to underdiagnosis.
No one looks at increases in cancer rates and decries them as an rising tide of overdiagnoses. Only when talking about mental health can people get away with this sort of shoddy reasoning. A few points:
First, the argument itself is faulty. By their very nature, diagnosis rates aren't able to support conclusions in either direction on the matter. An increase in diagnoses is not the same as an increase in misdiagnoses. There are multiple significant factors that can contribute to an increase in diagnoses over time (i.e. heightened awareness, decreased in stigma that would otherwise have prevented the patient from seeking treatment, better diagnostic tools, properly recognizing edge cases where ADHD was previously misdiagnosed, etc.). We've seen similar things with other illnesses as well.
Simply put, the question that you're trying to raise (but aren't) is more nuanced: what percentage of those diagnosed do not meet the diagnostic criteria? The two questions are quite distinct.
Second, we're not exactly working from a comparable baseline when we look towards previous years. Consider factors such as a broader recognition of ADHD symptoms, openness to not simply writing those same symptoms off as "that's the way the world works" or "kids will will be kids", and relative decreases in stigmatization of ADHD itself (e.g. "ok, this is different from those really bad disorders like... schizophrenia [gasp]"). Net result, increased visibility which damn well ought to lead to increases in overall numbers just as it would for any diagnosis, psychological or otherwise.
Third, there isn't much scientific evidence to support the idea that ADHD is overdiagnosed. Even in cases where patients don't meet the diagnostic criteria, there's a growing body of evidence that they nevertheless exhibit more symptoms than average. So even in those cases, they're quite different than your idealized vision of regular kids being fed a daily diet of all the psychopharmaceuticals they can swallow. If you're interested, here are a few articles you can start off from:
Anyhow, mental illness--regrettably--has a nasty assortment of baggage. For centuries the mentally ill were criminalized, marginalized, and locked away. Crazy or not crazy. And though we've moved away from a great deal of the worst of these excesses, many of them are still with us. Maybe one day we'll get our heads out of our collective asses.
Denying the existence of mental disorders is dangerous and harmful to those who indeed have these disorders.
And they are disorders. The science on this is very strong. You see "clusters" of similar conditions in millions of human beings, where each of these clusters/diseases have similar problems, and they share potential remedies.
The problems these disorders cause the individual are very real and unmistakeably negative. Sometimes this is muddied by people claiming schizophrenia, ADHD and bipolar disorder have "hidden benefits", especially creativity. Sometimes conspiracy nuts equate mental disorders with some kind of "dissident" behavior that has to be censors. It's not. These people suffer, and it's not only society that makes them suffer, but also their brain biology...
> The science on this is very strong. You see "clusters" of similar conditions in millions of human beings, where each of these clusters/diseases have similar problems, and they share potential remedies.
Would that were true! In fact the science is not very strong at all. We have descriptive sets of symptoms and we have classes of drugs discovered serendipitously that seem to help some sufferers, but despite 30+ years of effort we have little more than post hoc justifications for mechanisms of action and underlying causes.
The chemical imbalance theory has very little evidence going for it besides circular reasoning.
We are at the point in the science of mental illness where we go and categorize things -- this animal has a spine, gives birth to live young, and is warm blooded -- okay put it in this order. We need a Darwin, or at least a Mendel.
Depression for example is a very real problem for those affected. Several drugs are available which provide repeatable relief. Countless studies show, that suicide can be prevented through anti-depressants which mostly don't cause major side effects, leaving the patient much better off.
A lack of understanding why these drugs work does not mean that the diseases they are often successfully treating is "phony".
I certainly agree that major depressive disorder is a real problem, and drugs help it.
But there are two problems with the current consensus that I take issue with.
One is the that it's easy to medicalize normal human variation. Two years ago after an intense battle, I lost my mom to brain cancer. That same year, I lost three other people and had some other majorly bad things happen. At some point I talked to a therapist about depression. She agreed I matched the symptoms, but disagreed that I was depressed. I was grieving, and in her view I should work through it, no matter what other people thought.
I retrospect I can see she was right; I had work to do. But at the time, it would have been very tempting to take a pill that suppressed the symptoms. That's certainly what some people who told me I should be "over it by now" thought I should do. Our current society just doesn't have a lot of room for that.
The other problem I have is that we are putting things like depression all on the individual and some posited internal flaw. I think that's a lazy and disrespectful conclusion given the state of the art. For example, we are discovering that nighttime artificial light triggers depression in animal studies, and we know simulated extra daylight during the day can treat it in humans. For those people, their depression isn't a disease, it's an unintended consequence of our artificial environment. Daily pills to shift brain chemistry are one solution to the problem, but they aren't the only solution.
I think the disease model of medicine has been incredibly successful in improving human lives. But it has limits, and I think mental health is one area where we are overfitting the data to our model.
> Denying the existence of mental disorders is dangerous and harmful to those who indeed have these disorders.
The people you're talking about aren't denying the existence of real disorders, they're denying the existence of phony disorders -- and there are plenty.
Asperger's, popular a few years ago, is now recognized as a myth and has been removed from the DSM. Until the mid-'70s homosexuality was listed among the phony mental illnesses, finally removed after much pressure was put on the practitioners of this pseudoscience.
> The science on this is very strong.
The science of this is practically nonexistent. Are you aware that the director of the NIMH, the highest-ranking psychiatrist in the country, has recently decided to pull the plug on the DSM, describing it as too unscientific to be useful? And that, by pulling the plug on psychiatry's "Bible", he pulled the plug on psychiatry's dubious standing as a science?
> The problems these disorders cause the individual are very real and unmistakeably negative.
No more real than the average placebo response, which as time passes is becoming the default assumption that must be taken into account and that cannot be categorically eliminated until science eventually enters the field.
There is a core of very serious cases, like schizophrenia and some bipolar sufferers, but those are not mental illnesses, they are physical ailments with psychological symptoms. Purely mental illnesses have no scientific explanation, no reliable diagnostic criteria, and no treatments -- which is why the DSM is being abandoned.
> Sometimes conspiracy nuts equate mental disorders with some kind of "dissident" behavior that has to be censors.
You mean, like the editor of DSM-IV, now a critic of the mental health field, who has just written a book arguing that the epidemic of overdiagnosis collides with natural diversity? Like that? Are you aware that nature thrives on a wide spectrum of behaviors, that such a spectrum represents the genesis of all future improvements in the species?
Quote: "While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity."
>There is a core of very serious cases, like schizophrenia and some bipolar sufferers, but those are not mental illnesses, they are physical ailments with psychological symptoms. Purely mental illnesses have no scientific explanation, no reliable diagnostic criteria, and no treatments -- which is why the DSM is being abandoned.
What about depression? OCD? Anxieties? Are they "physical ailments with psychological symptoms"?
> What about depression? OCD? Anxieties? Are they "physical ailments with psychological symptoms"?
No one knows, and anyone who claims to know is speaking without any scientific backing. This will eventually change, primarily because of a move away from psychology toward neuroscience, but this is not going to happen quickly.
I will say this. Eventually "mental disorders" will all be either abandoned or turned into treatable biological disorders, diseases with know causes, just like medicine. But that's not around the corner -- it will take years or decades.
A neuroscience operation was recently performed on a woman who was so depressed that her life was essentially over -- she was institutionalized, unable to function at all. In the procedure, a location in the brain called "area 25" was stimulated using criteria that had worked with laboratory animals.
When the electric field was applied, the woman's depression lifted instantly -- instantly. The procedure is still experimental and is not safe for ordinary cases of depression, but it shows where we're headed:
It is examples like this that explain why I and many other people are advocating a move away from psychiatry and psychology -- the resources being expended on those activities are being wasted, and are taken away from things that might work.
ADHD has been well validated. Untreated it not only severely impacts "success" and "earning potential", it also leads to severe other problems like depression and social problems.
Face it: People with ADHD are way unhappier. And that isn't entirely the fault of society. If you are more impulsive, less able to take care of yourself or others, then it is really hard to imagine how you are supposed to feel as well as others...
So has Bigfoot. The difference between Bigfoot and a Grizzly bear is tangible evidence.
Want to prove that ADHD is real? Meet science's requirements, primarily a defined cause, unambiguous evidence, and falsifiability -- the possibility of definitively saying that a given person does not have ADHD.
This is not to argue that ADHD doesn't exist -- it is to say that this is not a matter of science, and until there's some science, anyone can claim to have ADHD, or PTSD, or Asperger's, or claim to have been raped by her father when she is in fact a virgin:
There will eventually be science where psychology now stands. But that process cannot begin until people begin to adopt a skeptical outlook appropriate to the subject's unscientific basis.
This is why the NIMH has decided to drop the DSM, and psychiatry along with it.
> Asperger's wasn't "removed" from the DSM-IV, as you claim
First, I never said any such thing. Asperger's was removed from DSM-5, not DSM-IV.
Second, Asperger's was removed from the current DSM, i.e. DSM-5. It was removed because, as one of the voting committee members said, "it's not a evidence-based term."
Asperger's wasn't "folded into" anything. It was recognized as a condition that was so vaguely defined that it could mean anything or nothing. What was folded in the the autism spectrum are those individuals who actually want continued treatment for something less romantic and more stigmatizing.
It wasn't Asperger's that was folded into the autism spectrum, it was those people who, after losing the chance to have a mental illness diagnosis in common with Bill Gates and Albert Einstein, still plan to have anything to do with psychiatry or psychology.
The "slightest deviation" hypothesis has been conclusively disproven. ADHD positive by American standards correlates with -10 IQ points, double the rate of serious injuries, much lower age of first pregnancy and much higher rates of promiscuity, dramatically lower rates of high school (secondary school) graduation, almost total inability to complete a university degree, amd very high rates of criminal conviction (at least half of prisoners are ADHD positive).
The American ADHD criteria are hard science, derived by looking at a syndrome of social failure and back-calculating diagnostic criteria.
The European approach, in contrast, is based on Freudian dogma. I.e., weapons grade malarkey.
The big thing this article misses is the god awful state of Child and Adolescent Mental Health Services in the UK.
MH services in England for adults are overworked and under funded, and that's much worse for CAMHS.
This is a left over effect of the weird split by age for services (children; working age adults; older adults; learning disability) which we used to have. Those lines are blurring. If you have a dementia like illness you go to a dementia specialist, and it doesn't matter if you're 40 or 70. If you have a first episode of psychosis you go to a psychosis specialist and it doesn't matter if you're 15 or 28. (Although there does have to be splits for in patients, because it's problematic to have under 18s in adult hospitals.)
ADHD is real. (Weird that I need to say that, but there are the usual suspects in this thread with their hateful denial of mental illness.)
But bad parenting is also real. Disturbed behaviour as a result of abuse is real. The meds are troubling. It's important, to protect vulnerable children, that people with ADHD are correctly diagnosed (and medicated if needed) but that people without ADHD are not misdiagnosed. Diagnosis is probably not going to be done by GPs, but by CAMHS specialists, which means that children are going to have to wait considerable lengths of time to get the help they need.
Here's the UK advice for ADHD. Healthcare trusts do not need to conform to the NICE recommendations, but they need good reason if they deviate from these recommendations.
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[ 3.5 ms ] story [ 168 ms ] thread> A friend of mine is a psychiatrist who specializes in treating ADHD. She told me about a conference she went to recently, where someone presented an interesting paper.
> Apparently, there was an amazing study done relatively recently (last five years), in which they demonstrated that, in mice, exposure to nicotine during pregnancy results in higher rates of ADHD in the grandchildren (passed down through the female offspring exposed to nicotine in utero, not the males).
As with any study conducted on animals and not humans, there's an asterisk next to it, but these findings would be monumentally significant for understanding ADHD.
Separately, I've never understood why Adderall isn't approved for use in Europe (or, futhermore, why Vyvanse should be approved, if Adderall isn't - Vyvanse is just a more concentrated version of the d-enantiomer, making it more effective[0] and reducing the side-effects).
On an unrelated note, it looks like the copy editing on the article was a bit off. Concerta is a long-acting drug, just like Vyvanse (the article makes it seem like it isn't). Also, I'm not sure what to make of the sentence "The U.S. still dwarfs Europe in sales of ADHD drugs, but the rest of the world has been catching up."
[0] It's actually less effective by weight than Adderall XR, but that's because the mechanism it uses for the extended release is very different.
EDIT: It's interesting watching all six of the comments on here (not counting losethos's) get upvoted and downvoted in roughly equal proportions. Clearly this is a controversial topic on here; I only wish the those upvoting/downvoting would join in the discussion.
For shits and giggles, let's compare apples to apples. Desoxyn (Methamphetamine HCl). There you get the scary M word, but one that's FDA-approved and prescribed--though, admittedly, not commonly--by doctors. Same chemical substance minus the crystallized form, impurities, and of course, the world of illicit meth.
Oddly enough, Abbott Pharmaceuticals isn't synthesizing Desoxyn in their backyard meth lab ala shake-and-bake and Walgreen's isn't hawking it from the saddle bag of their pharmacists' motorcycles. Same substance, different context.
If you want to argue against possible long-term effects of d-amphetamine on developing children, do so. You certainly won't be alone, though for all the hysterics and despite thousands of long-term studies on its effects, there's a rather glaring dearth of support for that position. But, hey, "methamphetamine!"
They are very similar in pharmacology, so you'd be deluded to not compare the two. Same addictive properties, same deleterious effects on health, similar abuse potential.
In other words, your argument is inherently simplistic and purposely misleading. Despite similarities in structure, the pharmacodynamics differences between therapeutic usage of Adderall and illicit meth are significant. When you gloss over the differences, you're radically undermining your position. My point with Desoxyn, which you completely ignored, rebuts your position even more clearly.
Most medications have the potential for hazardous effects higher up the dose-response curve. That potential, however, doesn't magically negate clinical effects lower on the curve. A little is good, a lot (or with acetaminophen for instance, a little more) can be deadly. That's nothing new. Just as with potential for side effects, you and your doctor work to manage it during treatment.
On another note, when you raise the specter of crystal meth usage, you aren't just isolating it to matters of pharmacology. Especially when you're talking about usage externalities and societal benefits: the external costs associated with manufacture and distribution all come along as mental baggage with the words "crystal meth." Your hysterics purposely ignore this in order to make the comparison seem more damning on a purely emotional level.
Most people don't really realize what Adderall is, and American society as a whole seems to assume that doctors and pharmaceutical companies know what they are doing and are trustworthy, despite many indications to the contrary.
The pharmacology of "illicit meth" is no different than the pharmacology of legal methamphetamine, other than some contamination. The pharmacology of dextroamphetamine is not so different either, mainly it comes on slightly more slowly and lasts less time.
The reason that crystal meth usage is so bad for society is because the drug is truly terrible for you. I am well aware of everything you said, and I disagree that "just a little bit of amphetamines" is helpful for kids to be receiving for ADD.
I'm confident that history will see me out on this. If you want to give your children speed, have fun.
This logic could also be used to argue that acetaminophen / ibuprofen should be Schedule I narcotics since taking a dose 30x - 50x larger than the therapeutic dose would almost certainly result in death.
I disagree with your comparison of acetaminophen and amphetamines. It seems to be based on your deluded idea about dosage, but other than that, the drugs differ in some rather significant ways such as abuse potential, habituation, psychoactivity, and so forth.
You can disagree with my comparison if you'd like, but the fact remains. Don't take my word for it - I encourage you to read some of the research out there surrounding therapeutic methamphetamine as well as the more common levo/detroamphetamine.
Amphetamines are highly addictive. They require perpetually higher doses to maintain the same activity in the body, like most other highly addictive substances. I'm sure there are some legitimate therapeutic usages for these drugs (narcolepsy). However, I see them as massively over prescribed to people who do not actually require them.
Almost by guarantee the child will not achieve remotely as well as it could. Both in school and within social groups. Both of these failures will almost by guarantee lead to further problems down the road.
It has been shown that untreated ADHD multiplies the risk for other very real disorders, like bipolar disorder for example.
Perhaps some children need this. The vast majority receiving these drugs would benefit a lot more from realistic parenting and school situations than from a toxic, addictive stimulant pill.
These side effects need to be severe, given the massive amount of consequences of untreated ADHD.
A short non-exhaustive summary: visible symptoms, effects on specific cognitive tests, reversal of symptoms under treatment, significant changes in neuroanatomy and brain activity in MRI, differences in EEG spectra and severe consequences like lower Income, higher propensity for violence and addictive behavior plus a markedly worse social life.
My experience being switched from Adderall XR to Vyvanse a few years ago when it first came to market in the U.S. has been positive. Vyvanse seems less addictive (missing a week or two between prescriptions is not a big deal) or prone to side effects like insomnia.
Obviously, I'm not your doctor.
Not at all; it's a prodrug that is converted into the d-enantiomer by your liver, at whatever your xenobiotic-metabolic speed is.
The major result of this has nothing to do with how safe a regular pill-dose of Vyvanse is vs. Adderall (or, equivalently, Strattera vs. Ritalin.) Instead, the effect is that you can't convert Vyvanse into an injectable or smokable form to make it absorb faster. There's no simple physical process you can put prodrugs through to turn them into something that will get you high; they need the full biological environment of your liver to be "unlocked", and it will only do so at a rate safe for you. (Or it'll create cytotoxins if you overload it, but this still won't get you high.)
And because of this, it's much safer statistically to prescribe it; with Adderall/Ritalin, there is a high chance that any voluntary self-diagnosed case will turn out to be a junkie/drug-seeker/drug-seller. With Vyvanse/Strattera, that potential for "malicious use" doesn't exist[1]. There are still all the same medical dangers, to be judged by doctors on an individual basis -- but there's a far lower worst-case downside in prescription.
(Further, prodrugs aren't addictive when taken at recommended dosages, since addiction is [likely] caused by your brain correlating spikes in its chemistry with recent memories, and prodrugs aren't "spiky" in the way their raw agonist or reuptake-inhibitor forms are.)
---
[1] Well, it does, but only in the nootropic/"study drug" market; not on the street.
The fact that Vyvanse is a prodrug is emphasized heavily in its marketing, but the anti-abuse potential is overstated, IMHO. Even some very cursory searching on Bluelight, et. al. will yield a dozen ways to either magnify or dampen the effects of Vyvanse using common foods, etc.
> with Adderall/Ritalin, there is a high chance that any voluntary self-diagnosed case will turn out to be a junkie/drug-seeker/drug-seller.
Well, we can't prescribe any psychiatric medication, addictive or not, to people who are "self-diagnosed".
I meant "self-diagnosed" as in "books an appointment with a therapist because they think they have X, whereupon the therapist tests them for X, and then sends them to a psychiatrist who tests them more carefully for X and, finding that they do have X, prescribes them medication for X."
Junkies can and do game this by looking up the tests online (which are, if you didn't know, just battery self-assessments of correlated behaviors.) But the only way to prevent this (besides coming up with objective measures for ADHD involving fMRI scans, like they've done for depression) would be to only prescribe neuroaffective medications to people whose lives take such a bad turn that they end up talking to a psychiatrist involuntarily (i.e. in a mental ward), thus preventing anyone who is self-aware-enough to notice that they have a problem from solving it.
The potential abuse of the system does not mean it doesn't do more good than harm.
Here's a PDF of funding for the European Brain Council. (http://www.europeanbraincouncil.org/pdfs/Publications_/EBC%2...)
Taming wild animals, until they are tamer than tame.
"Become bored with a task after only a few minutes, unless doing something enjoyable"
"Have trouble completing or turning in homework assignments"
"Struggle to follow instructions"
"Be very impatient"
"Be constantly in motion"
"Thinks constantly being told what to do by others for 18 years kinda sucks"
http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity...
Obviously there are trained doctors and psychiatrist and whoever who can judge whether or not a kid suffer from adhd but it seems that it will be way more than 7% of kid that could get bored by tasks they are being test for and that is why adhd seen from outside the usa feels too often diagnosed.
Others have said how the drug would have helped themselves or is helping themselves but has it been shown that the drug would not help everyone who takes it to focus and perform better at test and studying or working. Since I live in the USA, I have asked the questions to college student and it seems a fairly common thing to take a pill before exam to get that extra edge for focus (granted you don't start cleaning your apartment and become very thorough while doing it).
Even if the drug could help some people, it is not unreasonable to consider whether introducing the drug to society has an overall benefit and not just a benefit to the company selling it. France has already a problem with to many prescriptions of anti depressor drugs so maybe it is not a good idea to jump on adhd pills.
- Not able to drive unless taken medication since every sign, pedestrian, other cars and movement keeps you from paying attention to what is in front of you (including lights, cars and pedestrians). (Like running into a tree since you were trying to admire the forest and not paying attention to where you were going).
-Stopping mid sentence/conversation to finish a sentence/conversation (whether or not with the same person) that may have happened weeks or years ago.
-Being verbally told something, and remembering it until someone else tells you something/asks for something or you see something else 'shiney'.
-Finishing someone else's sentences due to them being too slow to finish it (whether or not what I say is correct)
-Having many projects half finished- not necessarily since I got bored with them, but it took to long to finish and something else more shiney/important happened.
-Finishing a book 4 years later, always knowing where in the plot you are and what is going on, but not finishing because another book wanted to be read first.
-Saying/writing a sentence wrong since you try to say the same thing 2-3 different ways ALL AT ONCE. Also works trying to move 2-3 different directions all at once.
-Impulsivity- trying to do Everything RIGHT NOW.
The way I think of it is like height. There's a normal range of tall and short. There are also diseases that make people unusually tall or short. But mere shortness doesn't prove disease. And just because short people have trouble reaching cabinets built for average people doesn't mean we must give short kids extra hormones to make them be average in height.
I think it's reasonable to say, "Hey, in the world we want to create, it's better if many or all people take drugs to shape behaviors so that they match the system they should fit into." Why I don't like is the medicalization of variation.
Those are interesting to mention in this context. It's a commonplace among hackers that a little OCD or a little Asperger can be beneficial in some circumstances. Indeed, Temple Grandin, perhaps the world's best-known high-functioning autistic, recommends computer programming as a career for people like her. Among artists, the same is true about Bipolar (the book Touched with Fire is an interesting study of why and how that's true).
I think it's relevant that Asperger was a valid diagnosis for a few decades, but it no longer is. (As of DSM-5, people are just placed somewhere on a spectrum of autism.) That's a great sign that we still have a lot to learn.
I'm sure you get this, but I worry that others will misunderstand me, so let me be clear here: I'm not saying that any of these things aren't a problem for people in today's society.
With attention span, for example, high-end classroom-style education and many high-end jobs require a great deal of focus. But that doesn't imply that people with lower-than-average levels of focus are diseased. Indeed, more than half of Americans consume stimulants daily, and many workplaces provide their staff with free stimulants (coffee, Coke) so they can keep up. Many unarguably normal students consume ADHD meds as study aids. If stimulants improve performance for everybody, they can't be considered diagnostic for a problem.
My concern here isn't that people are choosing that. We're half-evolved monkeys; it's great that we can choose who we want to be. My concern is that we're taking natural human variation and medicalizing it mainly because our current educational system finds some of that variation inconvenient.
ADHD is very real. So is the 50%+ of untreated people with ADHD having substance abuse problems. So is the higher suicide rate. So is the reduced rate of high school and college graduation. So are the dramatically increased rates of depression. Then there is the incredibly high rate of co-morbidity of ADHD with other psychological disorders, most prominently Bipolar Disorder.
Now obviously proving the entire causation thing here is pretty hard, but, if someone is missing their eyes, and that person is blind, there might just be a causative relationship happening.
To put it in perspective (http://www.medscape.org/viewarticle/549973), 32% of people with ADHD suffer from depression. 21% bipolar. That isn't some statistical oddity.
(The % is higher in the untreated population, no citation on hand right now sorry)
Over 50% of people with ADHD have substance abuse problems.
Imagine taking a population and saying "oh yeah half those people are alcoholics, but there is no strange underlying cause, nope, we should just let them be."[1]
ADHD isn't the popularized image of "little Johnny can't do his boring old homework that the mean teacher assigned", but rather "Jenny can't make herself go to sleep even though if she is late one more day for work she will be fired and have no money for food or rent."
ADHD is like having your entire sense of self control ripped away from you, no matter how much you want to do something, you cannot force yourself to do it. Pleading and begging doesn't work. Breaking down in tears over one's complete lack of ability to accomplish the simplest of tasks doesn't help any. The neurochemical responsible for self control quite literally isn't there.
[1] Well ignoring that America has basically done that for multiple cultures already...
What I'm questioning is constructing this as a mental disorder.
That's distinct from, say, psychosis. 100k years ago, being totally delusional would have been harmful. But there's no reason to think that most people classified as ADHD would have been at any disadvantage.
Again, come back to the height analogy (which you haven't addressed so far). There are obvious advantages in our society to being taller, including greater career success. Many short people hate being short. Does that mean there's something wrong with short people, or that they should all be treated with drugs as soon as we can diagnose Tallness Deficit Disorder?
I also feel that you are tending towards the naturalist fallacy here. Just because something is natural doesn't mean that it is good (or neutral). Mother nature doesn't care.
As for ADHD existing 100k years ago, a large percentage of ADHD cases are in children born to mother's who used drugs during pregnancy. (Obviously not all, but there is a very large %). One cannot discount at least some modern factors being responsible for some percentage of ADHD cases.
Amphetamine you may know better under its colloquial name -- speed. That's right, Shire Pharmaceticals is upset that European doctors and parents aren't rushing to give children fancy, expensive, speed.
http://www.youtube.com/watch?v=8T9Aa1V5oyo
But it's about Valium (diazepam) according to http://en.wikipedia.org/wiki/Mother%27s_Little_Helper
I'd think Speed would have helped mothers more than Valium, but my mom used to say that she and her neighbors just had martinis instead, and a Valium's just a much stronger version of a martini. Ah- the 60's.
After 8 years and 3 dropouts into my 4 year undergrad degree, I was finally diagnosed with ADHD. My pre-diagnosis GPA was 1.9, my post-diagnosis GPA was 3.9. I graduated less than two years later, and within 3 years I was earning a 6-figure income and providing for a wife and newborn child. I would likely be a divorced, homeless, deadbeat dad without Vyvanse (or its similarly Amphetamine-derived Adderall).
Don't take my life away from me, and don't take it away from anyone else, just because you have a fucking delusional conspiracy theory that a drug company is trying to addict kids to speed.
Among other things, Ritalin and friends used to completely suppress my appetite, which while it may sound cool, is really "not great".
For adults, only straterra.
You do sometimes see wellbutrin as an off-label use.
I'm also curious which side-effect you experience from strattera. In my mid-20's, I moved off amphetamines onto it, and have had no side-effects at all.
There is essentially no progress in this area because nobody cares. They keep finding new amphetamine derivatives to make, and they are quite cheap to produce, and still patentable.
Medicine in the form of antibiotics and inoculations against various dangerous diseases has brought us far, but it seems to be time to rethink some of the recent developments.
Maybe we can stop growing a monoculture of humans where the slightest deviation from the norm must be treated with some kind of drug.
I am from Europe (but live in the US) and I salute the folks there resisting this nonsense. (And for the record I am not saying there do not exist cases where treatment with such drugs would be indicated, just that the extend to which this is done in the US is not healthy).
Any disorder or disease that requires a potentially addictive medication will inevitably have crooked doctors - this is seen as well with patients requiring Morphine or Codeine. This crookedness is a separate issue from the illness, and is not relevant in a discussion about neurobiology.
In the UK, I didn't have to pay anything for refills of concerta. In NZ, I only had to pay the GP who gave me a referral to a free psychiatrist for methylphenidate and dexamphetamine sulphate.
In both places, it has been a relatively long journey to get medication. They were keen to try to resolve my issues without drugs - it was about half a year between when I started seeing a psychiatrist and when they suggested medication.
Personally, I was lucky, as I was diagnosed as a younger age (Around 5th grade or 6th grade). Recently I took a college course on handling ADHD in college, and my professor also had ADHD, having had it for many years, struggling with it, and not ever learning about it until she was around 50 years-old.
I agree with those who say it may be over-diagnosed, but at the same time, it's frustrating to see people who have no understanding of the disease at all tell me that it's all in my head and I should just get over it and act like everyone else. Being a bit older, I've learned to simply shake it off and move on, but it tough being a kid struggling to do stuff that others seem to be able to accomplish no problem, and then be told that you're simply not trying hard enough and never get any access to education on ADHD and/or medication. It's no different then going up to someone with depression and telling them it's all in their head and to just stop it. It simply doesn't work that way, and pretending it does only makes those with the disease feel worse about themselves without helping them.
Maybe we can stop growing a monoculture of humans where the slightest deviation from the norm must be treated with some kind of drug.
Yes, yes, and vaccines are a pharmaceutical industry plot, and all the rest. I am really tired of this amateur-hour analysis from people who can't even be bothered to muster up a citation for their hand-waving argument.
I have neither said nor implied this anywhere.
I'm very glad I didn't have to go through this, because in Europe it is much more difficult to be recognized as someone having ADHD.
So I'm sorry for you to have suffered, but I can't say I'm not happy I didn't.
All of this said, I no I have no data to back this up, it's just a gut feeling.
No one looks at increases in cancer rates and decries them as an rising tide of overdiagnoses. Only when talking about mental health can people get away with this sort of shoddy reasoning. A few points:
First, the argument itself is faulty. By their very nature, diagnosis rates aren't able to support conclusions in either direction on the matter. An increase in diagnoses is not the same as an increase in misdiagnoses. There are multiple significant factors that can contribute to an increase in diagnoses over time (i.e. heightened awareness, decreased in stigma that would otherwise have prevented the patient from seeking treatment, better diagnostic tools, properly recognizing edge cases where ADHD was previously misdiagnosed, etc.). We've seen similar things with other illnesses as well.
Simply put, the question that you're trying to raise (but aren't) is more nuanced: what percentage of those diagnosed do not meet the diagnostic criteria? The two questions are quite distinct.
Second, we're not exactly working from a comparable baseline when we look towards previous years. Consider factors such as a broader recognition of ADHD symptoms, openness to not simply writing those same symptoms off as "that's the way the world works" or "kids will will be kids", and relative decreases in stigmatization of ADHD itself (e.g. "ok, this is different from those really bad disorders like... schizophrenia [gasp]"). Net result, increased visibility which damn well ought to lead to increases in overall numbers just as it would for any diagnosis, psychological or otherwise.
Third, there isn't much scientific evidence to support the idea that ADHD is overdiagnosed. Even in cases where patients don't meet the diagnostic criteria, there's a growing body of evidence that they nevertheless exhibit more symptoms than average. So even in those cases, they're quite different than your idealized vision of regular kids being fed a daily diet of all the psychopharmaceuticals they can swallow. If you're interested, here are a few articles you can start off from:
- http://www.cdc.gov/ncbddd/adhd/play2.html
- http://www.psychiatrictimes.com/adhd/problems-overdiagnosis-...
- http://jad.sagepub.com/content/11/2/106.abstract
- http://www.ncbi.nlm.nih.gov/pubmed/22956714
Anyhow, mental illness--regrettably--has a nasty assortment of baggage. For centuries the mentally ill were criminalized, marginalized, and locked away. Crazy or not crazy. And though we've moved away from a great deal of the worst of these excesses, many of them are still with us. Maybe one day we'll get our heads out of our collective asses.
Mental illnesses predispose for bad health care coverage...
And they are disorders. The science on this is very strong. You see "clusters" of similar conditions in millions of human beings, where each of these clusters/diseases have similar problems, and they share potential remedies.
The problems these disorders cause the individual are very real and unmistakeably negative. Sometimes this is muddied by people claiming schizophrenia, ADHD and bipolar disorder have "hidden benefits", especially creativity. Sometimes conspiracy nuts equate mental disorders with some kind of "dissident" behavior that has to be censors. It's not. These people suffer, and it's not only society that makes them suffer, but also their brain biology...
Would that were true! In fact the science is not very strong at all. We have descriptive sets of symptoms and we have classes of drugs discovered serendipitously that seem to help some sufferers, but despite 30+ years of effort we have little more than post hoc justifications for mechanisms of action and underlying causes.
The chemical imbalance theory has very little evidence going for it besides circular reasoning.
We are at the point in the science of mental illness where we go and categorize things -- this animal has a spine, gives birth to live young, and is warm blooded -- okay put it in this order. We need a Darwin, or at least a Mendel.
A lack of understanding why these drugs work does not mean that the diseases they are often successfully treating is "phony".
But there are two problems with the current consensus that I take issue with.
One is the that it's easy to medicalize normal human variation. Two years ago after an intense battle, I lost my mom to brain cancer. That same year, I lost three other people and had some other majorly bad things happen. At some point I talked to a therapist about depression. She agreed I matched the symptoms, but disagreed that I was depressed. I was grieving, and in her view I should work through it, no matter what other people thought.
I retrospect I can see she was right; I had work to do. But at the time, it would have been very tempting to take a pill that suppressed the symptoms. That's certainly what some people who told me I should be "over it by now" thought I should do. Our current society just doesn't have a lot of room for that.
The other problem I have is that we are putting things like depression all on the individual and some posited internal flaw. I think that's a lazy and disrespectful conclusion given the state of the art. For example, we are discovering that nighttime artificial light triggers depression in animal studies, and we know simulated extra daylight during the day can treat it in humans. For those people, their depression isn't a disease, it's an unintended consequence of our artificial environment. Daily pills to shift brain chemistry are one solution to the problem, but they aren't the only solution.
I think the disease model of medicine has been incredibly successful in improving human lives. But it has limits, and I think mental health is one area where we are overfitting the data to our model.
The people you're talking about aren't denying the existence of real disorders, they're denying the existence of phony disorders -- and there are plenty.
Asperger's, popular a few years ago, is now recognized as a myth and has been removed from the DSM. Until the mid-'70s homosexuality was listed among the phony mental illnesses, finally removed after much pressure was put on the practitioners of this pseudoscience.
> The science on this is very strong.
The science of this is practically nonexistent. Are you aware that the director of the NIMH, the highest-ranking psychiatrist in the country, has recently decided to pull the plug on the DSM, describing it as too unscientific to be useful? And that, by pulling the plug on psychiatry's "Bible", he pulled the plug on psychiatry's dubious standing as a science?
> The problems these disorders cause the individual are very real and unmistakeably negative.
No more real than the average placebo response, which as time passes is becoming the default assumption that must be taken into account and that cannot be categorically eliminated until science eventually enters the field.
There is a core of very serious cases, like schizophrenia and some bipolar sufferers, but those are not mental illnesses, they are physical ailments with psychological symptoms. Purely mental illnesses have no scientific explanation, no reliable diagnostic criteria, and no treatments -- which is why the DSM is being abandoned.
> Sometimes conspiracy nuts equate mental disorders with some kind of "dissident" behavior that has to be censors.
You mean, like the editor of DSM-IV, now a critic of the mental health field, who has just written a book arguing that the epidemic of overdiagnosis collides with natural diversity? Like that? Are you aware that nature thrives on a wide spectrum of behaviors, that such a spectrum represents the genesis of all future improvements in the species?
"Saving Normal" (Allen Frances): http://www.amazon.com/Saving-Normal-Out-Control-Medicalizati...
NIMH director Insel: http://www.nimh.nih.gov/about/director/2013/transforming-dia...
Quote: "While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity."
Couldn't have said it better myself.
What about depression? OCD? Anxieties? Are they "physical ailments with psychological symptoms"?
No one knows, and anyone who claims to know is speaking without any scientific backing. This will eventually change, primarily because of a move away from psychology toward neuroscience, but this is not going to happen quickly.
I will say this. Eventually "mental disorders" will all be either abandoned or turned into treatable biological disorders, diseases with know causes, just like medicine. But that's not around the corner -- it will take years or decades.
A neuroscience operation was recently performed on a woman who was so depressed that her life was essentially over -- she was institutionalized, unable to function at all. In the procedure, a location in the brain called "area 25" was stimulated using criteria that had worked with laboratory animals.
When the electric field was applied, the woman's depression lifted instantly -- instantly. The procedure is still experimental and is not safe for ordinary cases of depression, but it shows where we're headed:
"A depression switch?" : http://www.nytimes.com/2006/04/02/magazine/02depression.html...
It is examples like this that explain why I and many other people are advocating a move away from psychiatry and psychology -- the resources being expended on those activities are being wasted, and are taken away from things that might work.
Face it: People with ADHD are way unhappier. And that isn't entirely the fault of society. If you are more impulsive, less able to take care of yourself or others, then it is really hard to imagine how you are supposed to feel as well as others...
So has Bigfoot. The difference between Bigfoot and a Grizzly bear is tangible evidence.
Want to prove that ADHD is real? Meet science's requirements, primarily a defined cause, unambiguous evidence, and falsifiability -- the possibility of definitively saying that a given person does not have ADHD.
This is not to argue that ADHD doesn't exist -- it is to say that this is not a matter of science, and until there's some science, anyone can claim to have ADHD, or PTSD, or Asperger's, or claim to have been raped by her father when she is in fact a virgin:
http://www.stopbadtherapy.com/retracts/beth.shtml
There will eventually be science where psychology now stands. But that process cannot begin until people begin to adopt a skeptical outlook appropriate to the subject's unscientific basis.
This is why the NIMH has decided to drop the DSM, and psychiatry along with it.
http://www.newyorker.com/online/blogs/elements/2013/05/the-s...
First, I never said any such thing. Asperger's was removed from DSM-5, not DSM-IV.
Second, Asperger's was removed from the current DSM, i.e. DSM-5. It was removed because, as one of the voting committee members said, "it's not a evidence-based term."
Asperger's wasn't "folded into" anything. It was recognized as a condition that was so vaguely defined that it could mean anything or nothing. What was folded in the the autism spectrum are those individuals who actually want continued treatment for something less romantic and more stigmatizing.
It wasn't Asperger's that was folded into the autism spectrum, it was those people who, after losing the chance to have a mental illness diagnosis in common with Bill Gates and Albert Einstein, still plan to have anything to do with psychiatry or psychology.
The American ADHD criteria are hard science, derived by looking at a syndrome of social failure and back-calculating diagnostic criteria.
The European approach, in contrast, is based on Freudian dogma. I.e., weapons grade malarkey.
This is from the CDC.
* 9.5 of all kids diagnosed with ADHD * 13.2% of boys * 22% increase of children with a parent-reported ADHD diagnosis between 2003 and 2007
Really? You think this is OK?
MH services in England for adults are overworked and under funded, and that's much worse for CAMHS.
This is a left over effect of the weird split by age for services (children; working age adults; older adults; learning disability) which we used to have. Those lines are blurring. If you have a dementia like illness you go to a dementia specialist, and it doesn't matter if you're 40 or 70. If you have a first episode of psychosis you go to a psychosis specialist and it doesn't matter if you're 15 or 28. (Although there does have to be splits for in patients, because it's problematic to have under 18s in adult hospitals.)
ADHD is real. (Weird that I need to say that, but there are the usual suspects in this thread with their hateful denial of mental illness.)
But bad parenting is also real. Disturbed behaviour as a result of abuse is real. The meds are troubling. It's important, to protect vulnerable children, that people with ADHD are correctly diagnosed (and medicated if needed) but that people without ADHD are not misdiagnosed. Diagnosis is probably not going to be done by GPs, but by CAMHS specialists, which means that children are going to have to wait considerable lengths of time to get the help they need.
Here's the UK advice for ADHD. Healthcare trusts do not need to conform to the NICE recommendations, but they need good reason if they deviate from these recommendations.
(http://www.nice.org.uk/Search.do?x=-1070&y=-75&searchText=ad...)
Here's the UK patient information about ADHD
(http://www.nhs.uk/Conditions/Attention-deficit-hyperactivity...)