It seems the number of children in the US having problems sleeping is increasing and the blame is being put on the drugs used to treat ADHD. Insomnia is a common side-effect of Ritalin and Strattera, stimulants often used for ADHD. About 15 percent of people under age 20 who received sleeping pills were also being given drugs to treat attention deficit and hyperactivity disorder. Worryingly there is not a sleeping drug that has been approved by the US Food & Drug Administration for under 18’s so doctors are prescribing drugs without information on recommended dosage and side-effects.
The expansive marketing campaigns by makers of sleeping pills has been blamed by some people for the rise and they predict the figures will be worse in 2005 because those campaigns expanded in 2005 after the introduction of a new pill, Lunesta.
This data comes from the Medco’s 2005 survey (covering data upto 2004) that we covered in ADHD Meds Cost and Usage Increase
ADD / ADHD Medication
ADHD Medication such as Ritalin or Adderall
ADHD Medication: Best Buys
Sitting here in the UK, the US medical system looks very strange. The difference between the two systems is exemplified by this consumer report on the ADHD Drugs best buy. In the UK we take what the doctor gives us. This is not to say that the UK system is better because in the UK we wouldn’t of gotten the useful information in this report.
"Our analysis found no evidence that any one stimulant drug is more effective than any other. Each raises different safety issues, however, and you should discuss these with your doctor. ….
Taking into account the evidence for effectiveness, safety, dosing convenience, duration of action, and cost, we have chosen the following as Consumer Report Best Buy Drugs to treat ADHD:
* Methylphenidate tablets – 5mg, 10mg and 20mg
* Methylphenidate sustained release tablets or capsules (Metadate ER, Metadate CD, and Methylin ER) – 10mg, 20mg, 30mg
* Dextroamphetamine tablets – 5mg, 10mg
* Dextroamphetamine sustained release or long-acting tablets – 5mg, 10mg and 15mg
These four medicines have been tested by time, and are available in low- or moderate-cost generic or "branded" generic forms. Their monthly cost ranges from $10 to $86.
Methylphenidate (short- and long-acting) is supported by more evidence than dextroamphetamine. Dextroamphetamine also causes slightly more side effects and has a higher potential for abuse. But all four have been proven effective."
Strattera Suicide Risk
The US Food and Drug Administration today announced it is issuing a Public Health Advisory on Strattera, a drug used to treat ADHD. The drug, also known as Atomoxetine, has been linked to suicidal thoughts in young people taking it and one boy is known to have attempted suicide.
FDA ALERT [09/2005] Suicidal Thinking in Children and Teens
- new or increased thoughts of suicide
- changes in mood or behavior including becoming irritable or anxious
The FDA looked at 12 short-term trials involving over 2200 children. During the first few months of treatment about 4 per 1000 children reported having suicidal thoughts. In trials of adults there were no reports about suicidal thinking. The BBC is reporting that the UK’s Medicines and Healthcare Products Regulatory Agency (MHRA) has issued a similar warning. According to the BBC there have been “11 reports of suicidal thoughts or behaviour among an estimated 15,000 users“. The MHRA haven’t yet managed to get their own press release on to their own website so I can’t confirm the BBC’s figures.
Strattera [Wikipedia] uses a different approach to treating ADHD to drugs like Ritalin. Most ADHD drugs are central nervous system stimulants that help keep the user focused. Strattera is a selective norepinephrine reuptake inhibitor (SNRI). This class of drugs effects the brains chemical balance by preventing norepinephrine, a chemical used in the brain, being absorbed back into the body. This raises the levels of norepinephrine which improves the brains ability to concentrate. As a treatment it only works for some patients but it is better than Ritalin style drugs because it can be used 24 hours a day and can’t be abused. The link to suicide is not surprising as Prozac which works in the same way but on serotonin rather than norepinephrine have also been linked to sucidal behaviour.
In addition to suicide, Strattera has also been linked to liver damage.
Eli Lilly, manufactures of Strattera, press release
Insurers Question If Adderall Works
According to the CDC, ADHD sufferers with insurance are three times more likely to be taking medication than those with insurance. In total, the US spends $250 billion a year on medication and now the insurers and Medicaid programs are starting to ask awkward questions about the effectiveness of all these medication. This article on the growing battle between pharmaceutical companies and the organizations that pay for the drugs has an interesting quote:
"When she reviewed Adderall, a stimulant now marketed by Shire Pharmaceuticals Group PLC to treat attention deficit hyperactivity disorder, she noted that one of the major trials included only people who had responded well to Ritalin, another ADHD drug. She thought the move likely improved the results. Dr. Kubota recommended leaving Adderall off Kaiser’s formulary. The physician committees partially overruled her, putting Adderall on the Northern and Southern California formularies but only for patients who failed to respond to another stimulant. Adderall later was added to the preferred list as a first-line treatment after a once-daily formulation went on the market.
A spokesman for Shire, Matt Cabrey, said that the designers of the trial, which was conducted when Adderall belonged to another company, felt that for ethical reasons they should give the drug to people with a "reasonable anticipated reaction." James Swanson, the lead author of the article that described the trial’s results, said the trial was designed to show whether Adderall works faster than Ritalin".
This means that a major trial of Adderall was conducted on people who had already taken Ritalin. This is very different from giving it to people with no experience of other drugs. because the Ritalin users have already been shown to respond well to stimulants so reports of side-effects or poor effectiveness would be reduced.
See also: ADHD, Children and Medication , FDA Concerns Over ADHD Drug Concerta, ADHD Drug Market: $2.7 billion
Are ADHD drugs safe?
Medication like Adderall, Concerta, Strattera and or course Ritalin do not treat ADHD they only help with the symptoms so ADHD sufferers need to take them for years, possibly for the rest of their lives. What effect does that have on your long-term health?
The Oregon Health & Science University is running a drug effectiveness review program which compares medications and works out the most effective. They have just published a massive study into medication for ADHD. Unfortunately it is not online but there is coverage in The News Tribune . Their findings were:
In short, we don’t how the drugs work, what effect they have over the long term or that they help in academic behaviour.
See also: ADHD, Children and Medication , FDA Concerns Over ADHD Drug Concerta, ADHD Drug Market: $2.7 billion
RoboMemo Featured in Scientific America
A study on Robomemo which Myomancy covered a few months ago (Memory Training Aids ADHD) has been covered in Scientific American. The article, Training the Brain – Cognitive therapy as an alternative to ADHD drugs, has little new to say about the software but does mention the Multimodal Treatment Study. This study has published results after 14 months (A 14-Month Randomized Clinical Trial of Treatment Strategies for Attention-Deficit/Hyperactivity Disorder) and concluded that a well designed drug treatment program was the best approach to ADHD treatment. However the Scientific American article has this to say: “Unpublished data from the Multimodal Treatment Study … show that after two years, kids treated with behavioral therapy only (parent training, school intervention and a special summer camp program) functioned just as well as kids on high-dose medication, says lead researcher William Pelham of the University at Buffalo“. Suggesting that over the long-term, 2+ years, training ADHD sufferers to think and behave differently is as effective as giving medication.
The National Institute of Mental Health has a FAQ on the Multimodal Treatment Study.
(Thanks Intelligence Insights).
ADHD Meds Cost and Usage Increase
The Medco’s 2005 Drug Trend Report [PDF 5.8MB] details how the USA is using prescription drugs of all types. Near the beginning of the report, under the title ‘Fast Movers’ it says:
“ADHD drugs. Trend: 30.5% [increase]. This therapeutic class includes CNS stimulants and nonstimulants that are used to treat ADHD, narcolepsy, sleep apnea, and other CNS-based disorders. The rapid trend reflects a strong increase in utilization for the drugs in this class (14.0%). Unit costs have also risen rapidly (14.5%), due to price increases for the brand-name drugs and a shift in therapy mix toward increased use of Strattera“.
So not only has medication usage gone up but its got more expensive. Another titbit in the the report:
“The use of ADHD drugs in adults is a significant new market that has already begun to drive utilization growth in this category. Only 13% of adults with ADHD are currently being treated“.
The report highlights the advertising campaigns the pharmaceutical companies are running in the US specifically targeting adults. To a UK citizen the idea of a drug company advertising prescription drugs on TV seems bizarre. On Newsday.com, in the article Surge in adults on ADHD drugs they dug up a couple interesting statistics:
“released today, shows use rose 113 percent among women 20 to 44 and 104 percent among women 45 to 64, both far more than among men”
and
“Those figures dispel earlier beliefs that children ‘grow out of the disorder,’ said Dr. Patricia Quinn, a developmental pediatrician at the National Center for Gender Issues and ADHD, and an adviser to Children and Adults with Attention-Deficit/Hyperactivity Disorder, an advocacy group. ‘We know that 50 percent of adults continue to have problems with attention that affect their functioning,’ and many now are staying on medication beyond adolescence, Quinn said“.
ADHD Meds Usage in USA
This image is taken from a new Centre of Disease Control survey of ADHD sufferers and their medication usage in the USA. Its surprising to see such a variation in usage. Arkansas children are three times as likely to be on meds such as Ritalin as Californian children. A separate map shows the prevalence of ADHD diagnosis. Again a wide difference between states prevalence of ADHD diagnosis.
Overall 4.4 million US children have been diagnosed and 2.5 million (56%) were reported to be taking medication. Boys aged 16 years and girls aged 11 years were most likely to be diagnosed, 14.9% and 6.1% respectively. Generally non-Hispanic, primarily English-speaking, and insured children were more likely to be diagnosed. ADHD was diagnosed amongst boys significantly more frequently in families with incomes below the poverty threshold than in families with incomes at or above the poverty threshold. Medication was most common for ADHD children aged 9–12 years.
The CDC have a good page about ADHD.
See also: ADHD, Children and Medication , FDA Concerns Over ADHD Drug Concerta, ADHD Drug Market: $2.7 billion
Adderall: Benefits and Side-Effects
Ever wondered what its like to take amphetamines like Ritalin and Adderall. Read The Adderall Me, My romance with ADHD meds for a view from the inside.
Faking ADHD
University are high pressure environments where students risk a bad degree and poor prospects if they slip in their work. Human nature being what it is, students are always trying to get the most benefit from the least work and in modern University’s this means the use of stimulants. The journal Addiction examined the use of prescription stimulants for non-medical purposes. Over 4% of students questioned had used the stimulants in the past year and also “use was higher among college students who were male, white, members of fraternities and sororities and earned lower grade point averages. Rates were higher at colleges located in the north-eastern region of the US and colleges with more competitive admission standards. Non-medical prescription stimulant users were more likely to report use of alcohol, cigarettes, marijuana, ecstasy, cocaine and other risky behaviors.”
Its not just the stimulants like Ritalin that ADHD sufferers get, they also get extra time in exams and coursework. This has raised fears that students will attempt to fake a diagnosis of ADHD in order to gain access to stimulants and the extra time. To examine this possibility a new study was carried out to see how hard four standard diagnostic tools are to beat. Eighty college students were given five minutes to study the symptoms of ADHD and then take self-report questionnaires.