Are ADHD Medications Safe for Kids?

I see a troubling trend in the pharmacy that has been going on since I started working with a license. And it’s probably no surprise since if you clicked on the link, you already know what I’m going to be discussing today.

ADHD? No problem. There's a pill for that.

ADHD? No problem. There’s a pill for that.

I see kids as young as 3-4, yes that’s right, 36-48 months of life, on ADHD medications. That’s quite interesting to me. I’m not going to be discussing the idea that ADHD might not be real. I will discuss the drugs and implications.

The story usually goes something like this:

A child has a lot of energy and can’t focus in school. Parents of said child get a note or call from a teacher about the disruptions, lack of attention, not working on assignments etc. Mom takes a child to doctor and, after performing some routine tests (at least we hope so), mom receives a prescription for some Ritalin, Adderall or other stimulant, goes to the pharmacy and gets to talk to the pharmacist.

This is where more truth comes out because we pharmacist have to disclose more information than a doctor typically would, or would want to. Side effects include; dizziness, sleepiness, decreased appetite, weight loss (that’s why meth addicts are so skinny), high blood pressure, arrhythmias, seizures, priapism, growth suppression, nervousness, insomnia, tachycardia, nausea, headache, palpitations, and visual disturbances.

Truth be told, many people like the effects of stimulants because they get you going, help you feel good, and can hit the pleasure centers of the brain to cause euphoria and if used long enough, or if the effect is strong enough, addiction.

I’ve talked with moms who’ve seen some of these effects in their children. The most common is weight loss and lack of appetite, which go hand in hand. Many also have nausea, compounding the weight loss problem.

What’s worse is that many are getting antipsychotic medications and/or anti-anxiety medications. We’re talking the big guns like benzodiazepines (Xanax, Ativan, Klonopin) and dopamine blockers (Risperdal, Seroquel, Geodon). According to a report from Columbia University, rates of antipsychotics have doubled in children ages 2-5 from 2000-2007. [1]

What’s worse is that less than half of these children actually had any kind of mental health evaluation, visit with a psychiatrist or have a psychotherapy visit.

One story of an 18 month old, yes 18 months, can be read at the New York Times [2] about how he was prescribed medications for temper tantrums. His condition got worse until his parents and some good doctors were able to wean him off everything other than some Vyvanse (a stimulant for ADHD).  He was overweight and his mother described him as having “blankness” in his eyes by the time he was three.

Part of the problem may be that our public school system is a one size fits all approach to students. We try to fit some square students into a round hole approach. For some children, the public school system works well, especially with good parent involvement. For others, it fails them horribly. I have no data to support the idea that a change in paradigm with public schools’ approach to education might actually curb the rate of prescribing of these medications, but I think it would.

That’s for another post though.

This type of problem solving is analogous to a report I heard on NPR recently about nursing homes and long-term care facilities. A team went to discover if the residents in these types of facilities were really demented and had other mental health problems. Many residents of these types of facilities will yell out and make other types of disturbances during the day and night.

The tea tasked itself with discovering if their really was mental illness or something else going on. In one instance, a woman would yell out at night. Many times in this type of situation, nurses will administer depakote (an anti-seizure medication) or benzodiazepines to calm a patient down.

This team tried to communicate with her. What they found was, after some time and effort, was that she was cold at night. They got her a blanket and she calmed down and slept, all without medications.

Communication: what an amazing concept!

Rather than not listening to yelling and grunting and crying, we should listen and see if we can discover the real problem

Rather than not listening to yelling and grunting and crying, we should listen and see if we can discover the real problem

Now I know some people do legitimately have mental illness, there is no doubt about it. Getting a proper diagnoses from the proper channels is important though. Immediately throwing a drug at a problem is a mentality that unfortunately, too many doctors and patients and patient’s moms have. Working through a problem rather than throwing a tablet at it is harder, but can be worth it. Avoiding problems like the story in the New York Times is advisable.

Proper nutrition and activity is generally a good idea, especially for very active kids. Some kids are content to live in their brains more so than others. Others just can’t sit still. They need to move.

A child’s brain is also continuously developing. To address problems like ADHD at 2 or 3, or a temper tantrum at the same age is probably very premature.

My little 3 year old gets frustrated sometimes because she desperately wants to say something. Even when my wife or I is listening intently she’ll get mad or begin to cry. When asked the problem her reply is usually, “I just don’t know how to say it.” Her vocab isn’t quite up to par so her mode of expression goes from words to crying. I certainly don’t fault her for being unable to adequately express in words what’s she’s feeling at the age of 3.

If you think your child may have problems with ADHD and want to take them to a doctor, that’s fine. I don’t disagree with that. But a psychological evaluation by a professional recommended by the doctor is a good place to start. In some cases, if medication is needed on top of a healthy diet and activities, there are alternatives like clonidine which can be prescribed that don’t carry some of the risks of stimulants, or the potential abuse among children or their friends.

CIAO

 

1.Olfson, Mark, et al. “Trends in antipsychotic drug use by very young, privately insured children.” Journal of the American Academy of Child & Adolescent Psychiatry 49.1 (2010): 13-23.

2.http://query.nytimes.com/gst/fullpage.html?res=9D02E0DE1E3CF931A3575AC0A9669D8B63

 

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Are Pre Workouts Helpful?: Theanine

This will be the last post in this series. If you’ve missed the other posts take a look at them as I covered some of the other supplements that are taken pre workout to help energize and otherwise allow you to increase performance.

Today we’ll take a look at a substance that many people already consume but might not know it. I’m talking aboutL-theanine which is yet another amino acid that some pre-workouts use in their formulations. Theanine is also very common in teas but not found in coffee. Green tea is probably the most popular but not by any means the only source of this stuff.

Theanine...just another white powder? Maybe not!

Theanine…just another white powder? Maybe not!

Theanine is best known for its ability to calm the nerves and kind of acts as a de-stressor. It can also be used for mood enhancement and focus. It even improves the sleep of boys with ADHD. [1]

So why would you want this before going out to pump iron, kick the soccer ball or ride your bike through the hills?

Well to be quite honest you don’t. But to be brutally honest no pre workouts are ever “really” needed. You can work out and progress and do just fine without them. In fact the only things you really need to progress in training are good obtainable goals, good food, good rest and a good attitude. I know that doesn’t sell supplements but I’m not selling supplements.

So should we just stop the blog post there and call it a day. Nope!

Theanine has this ability, when paired with caffeine, to make the caffeine jolt not quite so jarring. For some it can stop the jitters but the science says that’s probably not going to happen. It also stops you from going into full freak out mode when you get the caffeine. I remember the first time I had an NO-Explode. After about 15 minutes I was bench pressing while simultaneously running around the indoor track and doing push ups while squatting, the whole while breathing like I’d just run the fastest 100m in human history. Ok so maybe not quite like that, but it FELT like I was doing that.

Theanine helps level that out. I don’t take caffeine everyday, nor everytime I work out so to help me keep it even keel the theanine is what I prefer.

What does Theanine do?

Theanine actually helps dopamine release in the brain but also releases other chemicals that cause the “restful” effect. In the frontal cortex dopamine is thought to play a role in attention. Some believe that a reduced level of dopamine in this area is part of the cause of ADHD. For myself this is the effect I notice when taken with caffeine. The caffeine amps my brain energy, so to speak, and the theanine is able to focus it or direct it better than with caffeine alone. But this is just my anecdotal experience and may not be yours.

I couldn’t find any studies that show that theanine is an ergogenic aid with one exception in mice. Mice given theanine were able to swim a bit longer than the placebo group. Researchers attributed this effect to increase dopamine and decreased serotonin. [2]

Taking theanine on its own will likely not help you lift more or heavier, run longer or help muscle recover more quickly. The drug to accomplish all of that is called testosterone and I’m definitely not recommending that.

What theanine does do is allow the brain to recover from exercise. [3] When given 50mg theanine after initiation of exercise. Brain wave patterns of cyclists decreased in intensity and shifted to lower frequencies with theanine administration. It decreased the time to onset of mental regeneration. In other words it helped the cyclist calm down their minds more quickly.

Another thing theanine does is help with immune function. In a study done with distance runners, researchers looked at immune function of runners with cystine/theanine combo vs placebo. The combo kept the immune system running better than the placebo after 10 days of training. [4]

Another study shows the same thing in resistance training in men. [5]

It should be noted in these studies that a combination of theanine and cystine was used which means we can’t extrapolate the effect solely to the theanine. We’d need another study using just theanine to be able to say that.

So theanine can help mice swim longer, make people have better immune function in combo with cystine after exercise, helps the brain recover after exercise, and according to yours truly can help focus your caffeine jolt (this last one is unscientific).

Theanine has also been shown to help relieve stress. In a study done with theanine, caffeine and placebo, subjects were given mental tests and their blood pressures recorded at intervals during the tests and after. They were also submitted to a cold pressure test (submerging your hand in ice water for a minute) which is used to raise blood pressure.

In the groups there were high responders and low responders. In the high responder group there was a significantly less increase in blood pressure with the mental tests with both caffeine and theanine, but not with placebo. There was no difference with the cold pressor test. In the low response group there were not differences noted between the 3 groups. [6]

one interesting finding was that in the high responders group caffeine actually reduced blood pressure which is somewhat counterintuitive to what a person might initially think. This didn’t hold with the low responders group. It’d be interesting to do a study and see what mechanisms make those different.

This study shows that there may be some people who just don’t respond to theanine like others which is important to note. Just because you take theanine doesn’t necessarily mean it’s going to help reduce your blood pressure from the pangs of psychological stress.

Another study looked at similar parameters but with the addition of caffeine and theanine together. In this study caffeine alone increased blood pressure, jitteriness and alertness. When combined with the theanine the blood pressure increase wasn’t present but the jitters and alertness persisted.[7] This is similar to what I’ve experienced just less jitters. I don’t really get jittery with caffeine anyway.

On a stress study of pharmacy students going out to do rotations in clinical settings, researchers gave students placebo or theanine to two groups. The baseline stress levels were significantly higher in the placebo group and after use of theanine the subjective stress was less in the theanine group.[8]

The problem with this is the baseline of the 2 groups. If the placebo group had higher initial stress levels it’s possible that the results were due to chance or the treatment group actually just had naturally lower stress levels that the theanine might have accentuated. It would have been a better study had randomization taken place and made the baseline equal between the two groups.

How much?

In the stress studies mentioned above 200mg and above were used. In the mental regeneration study a dose of only 50mg was needed to ilicit an effect. In the study of boys with ADHD it was 200mg twice daily with food. i was once listening to a pharmacist at a national pharmacy convention talking about using a couple of grams before her talk to help calm her nerves down. She said it worked!

A dose of 200mg would probably suffice for most people. If you have higher stress levels a higher dose might be required. I haven’t found any real side effects except for maybe nausea but I’ve personally never experienced it and have not heard any complaints from anyone.

Theanine isn’t required for a pre workout to be a great one. But it does seem to have some ability to regulate caffeine and focus. I find the focus helpful during intervals but others may not. Only trying some can really tell you for sure. It shouldn’t hurt you though to try some and if you’re not looking for a pre workout but something else to calm down in the evening or need something to help during the day, theanine may be your answer.

CIAO

Disclaimer: All info on this website is for education purposes only. Any dietary or lifestyle changes that readers want to make should be done with the guidance of a competent medical practitioner. The author assumes no responsibility nor liability for the use or dissemination of this information. Anyone who chooses to apply this information for their own personal use does so at their own risk

 

 

1.Lyon, Michael R., Mahendra P. Kapoor, and Lekh R. Juneja. “The effects of L-theanine (Suntheanine) on objective sleep quality in boys with attention deficit hyperactivity disorder (ADHD): a randomized, double-blind, placebo-controlled clinical trial.” Altern Med Rev 16.4 (2011): 348-354.

2.LI, Min, Xin-nan SHEN, and Guo-ying YAO. “Effect of theanine on delaying exercise-induced fatigue and its mechanism [J].” Acta Nutrimenta Sinica 4 (2005): 019.

3.JÃger, Ralf, et al. “Improving mental regeneration after physical exercise.” Journal of the International Society of Sports Nutrition 5 (2008): 1-2.

4.Murakami, Shigeki, et al. “Effects of oral supplementation with cystine and theanine on the immune function of athletes in endurance exercise: randomized, double-blind, placebo-controlled trial.” Bioscience, biotechnology, and biochemistry 73.4 (2009): 817-821.

5.Kawada, Shigeo, et al. “Cystine and theanine supplementation restores high-intensity resistance exercise-induced attenuation of natural killer cell activity in well-trained men.” The Journal of Strength & Conditioning Research 24.3 (2010): 846-851.

6.Yoto, Ai, et al. “Effects of L-theanine or caffeine intake on changes in blood pressure under physical and psychological stresses.” J Physiol Anthropol 31 (2012): 28.

7.Rogers, Peter J., et al. “Time for tea: mood, blood pressure and cognitive performance effects of caffeine and theanine administered alone and together.” Psychopharmacology 195.4 (2008): 569-577.

8.Unno, Keiko, et al. “Anti-stress effect of theanine on students during pharmacy practice: Positive correlation among salivary α-amylase activity, trait anxiety and subjective stress.” Pharmacology Biochemistry and Behavior 111 (2013): 128-135.