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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What is Your Health Worth?

The answer to the above question really is priceless. Your health is one of the few things that truly affects you directly every single day. No one escapes it. Whether you feel like a million bucks or feel like someone just stomped a hole in you, you get to deal with your health and only you have the power to change it.

That’s right, only you have the power to change it. No one else can.

Sure you can visit a doctor to seek out treatment or advice, but it is you that made the decision to go, not the doctor. It is you that made the decision to take the prescribed medication. It’s you that decided to eat or not to eat something. It’s you that has control.

I thought it’d be fun to put some numbers up to look at this question. They won’t be exact, especially since everybody’s situation is different, but it will give an idea of money attached to healthcare.

Without any major hospitalizations here are a few things to consider:

If you have been diagnosed with hypertension at the age of 35 (something that isn’t uncommon) you can expect to be taking something for that, usually lisinopril is one of the first choices. You can get a 90 day supply at your local WalMart for $10. That’s $40/year. At first you’ll have a couple visits to the doc from the time you’re diagnosed as follow up to make sure you’re doing well on the medication. If you have a $35 copay that’s between $70-$105 total visits for the year, at least for the first year and assuming you go to the doctor for nothing else that year.

3 visits = $105

1 year of meds = $40

Total = $145

Subsequent years would look like this:

1-2 follow up visits/year = $35-$70

1 year of meds = $40

Total = $75-$110

Over 20 years ~ $1500-$2300

Now this is assuming a few things. First you don’t ever have problems keeping your blood pressure from going up after the initial diagnoses and treatment, which is rarely the case for most. This also assumes you have no problems with the initial medication and have to get it changed, although this wouldn’t add a whole lot.

If you’re on two blood pressure medications, this jumps to $2300-$3000 over 20 years. This of course is no mortgage but still it adds up. If you happen to be taking a beta blocker like metoprolol as one of those blood pressure medications your cholesterol might go up just enough to trigger a prescription for something like simvastatin. Add another 10 dollars a month for that one.

Simvastatin $120/year

Metoprolol (assuming the cheap immediate release) $40/year

Lisinopril $40/year

2 visits/year $70

Over 20 years ~ $5400/20 years or $270/year

If you become borderline diabetic because of the simvastatin and the metoprolol in combination or were already there and these push you over you might add some metformin into the mix for blood glucose control. Three months of twice daily metformin will run you another $40/year.

Total ~ $6200/20 years or $310/year

We’re still not even close to a mortgage, but we’re increasing.

Now we’ve only discussed the financial part of all of this. Metoprolol is also going to sap some of your energy because it prevents chemicals like epinephrine and norepinephrine from having their full phsyiological effect. What does this mean? Well as I said it will probably sap some of your energy depending on the dose. It won’t necessarily make you drowsy, but it will make you tired easily.

Simvstatin as well as others have the tendency to cause muscle pain and weakness. I’ve had members of my family experience this, and I’ve experienced it myself. Many older folks attribute this to older age. I call nonsense. Yes we do degenerate as time goes on but my own grandmother was able to walk again in her 80’s after stopping simvastatin. It really can be that bad for some.

I’ve talked to others who’ve told me about lisinopril or losartan (angiotensin converting enzyme inhibitor and angiotensin receptor blocker respectively) who describe feeling like people who are on metoprolol do, with a lack of energy. Not enough to keep them from being out and about, but enough to make a few dread having to do anything because they have no energy to do it with.

Instead of medications doing some physical activity 2-3 times per week and backing off on total calories every day will likely achieve what most medications are seeking to achieve. Going on a brisk walk and having only one plate at dinner are two things that go a long way in improving health.

Think about it for just a moment; if you have only 1 plate, or maybe a smaller portion, you save on food and caloric intake. Eating till you have to undo your pants button is ok on Thanksgiving, Christmas and your birthday,…ok and maybe 1-2 other times/year but that’s it. If having to loosen your belt regularly after eating is a habit I can tell you that the belt is only going to get tighter and tighter.

Taking a brisk walk or going on a hike or riding the bike or whatever it is you might find joy in will get your heart pumping and muscles working. Blood pressure will go down as some of the fat comes off and you will feel more energized and not get out of breath while doing things you love.

I personally wish I could go back to Tahiti now that my heart is conditioned better to be able to stay underneath the surface while snorkeling with the fish longer.

Having a plan and sticking to it will pay off dividens in the long run. It’s sad to see people who take their medications exactly as the doctor directs and have been doing so for a long time only to see them deteriorate. Don’t be a statistic. Change now! Plan for the future, however long that may be, and make a difference in your life.

I know the amount of money that we went over above isn’t a lot in the grand scheme of things, but that’s assuming you take the meds and nothing ever happens and you never deteriorate any further than where you are. Not having to deal with the side effects and not having to visit the doctor is worth going biking and feeling awesome at the same time.

CIAO