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Re: 504/IEP
Mar 16, 2011
Mom,

I too would worry myself sick over ADHD medications being given to a child. Let's again go to the facts strongly supported by evidence gained over the past 40 years through many case histories and scientific studies. Stimulant medications are among the safest meds prescribed for children.

Give this WebMD page a read.
http://www.webmd.com/add-adhd/guide/adhd-treatment-overview

Why then would I worry? We need a caveat and a caveat emptor addendum attached to the WebMD page.

Caveat 1) Stimulant meds are among the safest if prescribed to correct disrupted neurotransmitter signal flow through the dopamine and norepinephrine signal pathways. And said disrupted neurotransmission is one of the primary causes of the ADHD type. And no other medical problems contraindicate the use of stimulant meds. And the stimulant is dosed within their narrow window of efficacy. Stimulants help with attention up to the top of a very narrow bell curve of efficacy. A dose just over the peak begins to adversely affect attention. I previously mentioned that stimulants can cause emotional lability in some children with ADHD. Not true. Stimulants cause emotional lability in everyone when the dose is too high.

If Caveat 1) conditions and cautions are satisfied, stimulants are more than safe, they help manage ADHD's potentially dangerous consequences by reducing ADHD symptoms and the stimulant efficacy comes with few if any adverse long term side effects.

On the other hand, if caveat cautions are ignored, stimulant medications become dangerous medications. I would worry myself sick over my choice of doctors. I'd agonize over the doctors credentials by asking lots of questions. The psychiatric license hanging on his wall qualifies him for the interview, nothing more. One wrong answer given during his interview application to work for me disqualifies him from the job. I am not talking about "wrong" answers that run contrary to my opinion. I mean any answer that runs contrary to current medically accepted practices.

Caveat 2) I cannot find any evidence for a few of the statements made on the WebMD page. WebMD states "other FDA-approved drugs for ADHD in children include the nonstimulants Strattera ...(and Intuniv) Strattera works on levels of the brain chemical norepinephrine and is quite effective at treating and controlling ADHD symptoms."

I won't believe it until one person with ADHD somewhere on earth comes forward and tells me Strattera (alone) helped with their ADHD symptoms and did so without show stopping side-effects.

WebMD goes on to say:

"Both of these drugs [Strattera and Intuniv] pose a much lower risk of abuse or dependence than stimulants."

Study after study found strong evidence that stimulants when used to control ADHD in children, have the effect of lowering the risk of substance abuse in their teens and adult life. ADHD unmedicated or ineffectively medicated raises through the roof the risk of life-long substance abuse.

Both Strattera and Intuniv may raise the risk of abuse well over the risk of abuse from stimulants if they fail to control ADHD symptoms as effectively as stimulants.

WebMD's statement is absolutely true when taken in its immediate context: Medication options parents have if their children are abusing drugs. The statement is easily misunderstood. IMHO, it could cause parents to opt for ineffective medications only to find themselves later facing the horrible problem they so diligently tried to avoid -- their teen age children abusing drugs.

Caveat 2b) This excellent, accurate, and informative, WebMD article must be studied carefully.

WebMD accurately explains the many medication options available. If one type of stimulant fails to work, likely another type will work. We have three broad classes, Ritalin based, Adderall and Dexedrine. Adderall is not the same as Dexedrine. Adderall and Dexedrine have many properties in common but also have a few dissimuler key properties. If Ritalin fails, try Adderall, if Adderall fails, try Vyvanse (d-amphetamine). Adderall is a distinct medication from d-amphetamine.

A good doctor can see in the unique set of symptoms the medication most likely to work out of the gate. For example, I know that primarily inattentive ADD responds well to a relatively high dose of d-amphetamine. I know it because good doctors know it and I read their work.

If stimulant benefits are less than acceptable or are being outweighed by unacceptable side effects or are contraindicated by other medical problems, perhaps another med such as Wellbutrin can be used as a stimulant buffer. Why not simply discontinue stimulants altogether? We have no guarantee that any other type medication will work any better. WebMD does clarify later that if the benefits from a stimulant are being outweighed by unacceptable side-effects, trying to manage the side-effects is the wisest first course of action. Perhaps a lower stimulant dose possibly with the addition of another medication will get the desired results. Thunor has had excellent results from an Adderall and Wellbutrin combination.

WebMD goes on to explain that a SSRI can be added to the stimulant mix to control tics and prevent stimulant exascerbation of Tourrettes. Murphy's law always rules. Tourettes and ADHD, depression/anxiety and ADHD, and bi-polar and ADHD commonly run together.

I read a study (not WebMD) that concluded stimulants can be safely used to manage ADHD with bi-polar. I was shocked. I thought for sure BP+ADHD suffers were permanently stuck between bi-polar the rock and ADHD the hard place. The trick is to raise the dose on the mood stabilizers. The study "caveated" the therapy did not have FDA approval. Will street level doctors use the meds off-label confident in the accuracy of the study that used hundreds in both the control group and the BP+ADHD group?

Attempting to manage the side-effects assumes some efficacy from the stimulant and the side-effects are not life threatening. 25% of all ADHD cases do not respond at all to stimulants, stimulants make many in the 25% group worse. Discontinuing the stimulant immediately is best practice in these cases.

I guess I have one other bone to pick with WebMD. WebMD states: "Effexor and Effexor XR are newer antidepressants... The drugs are effective at improving mood and concentration in adults as well as children and teens - all true enough. WebMD fails to mention the horrible Effexor withdrawals. Some people choose hooked for life feeling it a better option than dead from withdrawals. FDA quotes 9% of Effexor users experience severe withdrawals. FDA defines "severe" as causing hospitalization, permanent disability or death. I'd choose life with ADHD if Effexor was my last option. Effexor is unlikely to become last resort for ADHD suffers. Do not allow Effexor for your son.

And in your son's case, if you choose to use ADHD meds, the ADHD meds will require careful balancing with other meds he may take for his physical ailment.

I barely touched the surface of medication management complexities. I wanted you to know what you should really fear - incompetent doctors - not ADHD medications.

Again, I couldn't possibly advise a better course of action than the one you are taking. Using multiple authoritative resources to piece the puzzle together can not be topped. Two opinions are always better than one. Three opinions? better yet.

Now, I'm done for real. I simply had to share with you information I consider critical.

Oh, what about the caveat emptor? You make sure the prescribed medications you purchase are suitable for the intended purpose. Buyer beware applies full force when buying prescription meds.

Never guess what? I found an answer to the question you asked opening this thread. I almost always get to point sooner than later, later far more fequently.

Your answer is in part found in the same department:

http://www.webmd.com/add-adhd/guide/adhd-treatment-overview?page=3

Here is a direct quote from the same page you'll find interesting:

[I]"Can ADHD be treated with dietary changes or vitamins?

In the past, experts and parents of ADHD children hoped that dietary changes -- no food dye, no sugar, and no salicylates -- could cure ADHD. Some experts championed megadoses of vitamins and natural dietary supplements as a possible "cure" for ADHD. Some parents claimed that a gluten-free diet helped to cure ADHD or improve the symptoms.

There's no denying that a well-balanced diet is most important for optimal health. But scientific studies do not support the idea that dietary factors or a vitamin deficiency actually causes ADHD."[/I]

Bob





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