This great parody of the classic Calvin & Hobbes cartoons highlights the problems and ethical considerations of using medication to treat ADHD.
Many thanks to The Ephemerist for finding this.
Before drug companies were convincing parents that their children needed stimulants, they were trying to persuade Grandma that she need Ritalin. Don’t believe me? Check out Grandma’s Little Helper about the history of Ritalin and its advertising.
One of the reasons I started this blog was because I was interested in creating a cerebellum training program that was quicker, more effective than Dore. Myomancy was my notebook of interesting technology and relevant science. Over the years I’ve examined many different approaches to the treatment of dyslexia and ADHD. Some were simply nonsense, others had promise but were lacking the scientific, technological or business resources to make them viable. Some lacked the ethical honesty necessary when selling products to parents desperately worried about their children.
Slowly overtime I refined my ideas about how cerebellum training should work and how a independent company without much in the way financial resources could develop and sell such a product in an ethical manner. One main stumbling block has been the cost and availability of the technology necessary to track a user’s limb movements and balance. So I’ve been watching the progress of the Wii and latterly the Wii Fit with interest. The technology needed for cerebellum training was finally cheaply and readily available. What’s more many people already own it.
Originally I intended to make an announcement after slowly develop a proof of concept over the next few months but with the collapse of Dore and the shadow that will cast over the cerebellum training field, I’ve decided to move my plans forward. So I’m pleased to announced the creation of WyyMi, a project to create a free, open-source, open-science cerebellum training program.
What is WyyMi?
WyyMi is a project to develop a cerebellum training program to help people with dyslexia, ADHD, dyspraxia and similar educational problems.
To develop a system that cost nothing (or as close to nothing as possible) to use; to do it using open-source software; and to make freely available as much scientific evidence on its effectiveness as possible.
How Will It Work?
The idea is to use cheap and easily available computer hardware that can monitor and assess gross motor movements and balance. At the moment the Wii Remote and Wii Fit Balance Board seem the best candidates but they need to be adapted to work on PCs and Macs because the Wii console itself is difficult to develop for.
Using this hardware and software on the website, users will be perform a series of exercises. The amount of time spent training and the accuracy of the user’s movement will be logged on the server so that the user can track their progress and so the server can inform the user which exercises to do next. This data will also be aggregated, made anonymous and published so that it can be analyzed by any interested 3rd party. Ideally, symptom specific measures (e.g. spelling tests) will also be included so that the training programs effectiveness in treating educational problems can be measured.
Other than a broad statement of goals and the planned route for achieving them, there is nothing else on site at the moment. Progress is likely to slow, not least because I am working on another project at the moment as well maintaining my existing portfolio of web sites. If you wish to help in anyway, please see the announcement for ways you can contribute, not matter what your skills are.
Myomancy will be continuing to report on anything and everything I think is relevant to dyslexia, ADHD and autism. Obviously as I am planning to create my own training program, that might create a conflict of interest when discussing other people’s approach. I will try and be as unbiased as possible and make my conflict of interest clear.
Intuniv is the latest ADHD drug from Shire PLC, the makers of Adderall XR, for tackling ADHD and it marks a big change in potential treatment options. It is not a stimulant like Ritalin or Adderall but instead its a selective alpha-2A receptor agonist. More simply, the active part of the drug helps specific parts of the brain to function more effectively. The key to making it an effective ADD medication is that it targets the area of the brain relating to the central nervous system. This, in theory has a calming effect, suppresses the fight / flight response and allows the normal functioning of the brain.
Intuniv is based on the drug Guanfacine (also known as Tenex) that is used for treating hypertension and blood pressure. In 2006 the makers applied to FDA to allow its approval as a treatment for ADHD and this was granted in June 2007. However Guanfacine is only effective for a few hours before the patient has to take more pills. In the ADHD market, parents want to be able to give their child a tablet in the morning before school and have it working all day. This makes life easier for the school who no longer have to give out medicines at lunch time.
Adderall XR has been very successful for Shire PLC because it proved to be an effective, time release version of the standard stimulant used in Ritalin. Intuniv is very much in the same mold. Taking the existing drug Guanfacine and repackaging it in a time delayed formula. It is not clear exactly how it works but most likely it will use the same system as Adderall XR. The pill effectively consists of two tablets, one of which dissolves quickly in the stomach providing an immediate dose, and the second tablet, protected by a special coating, dissolves a lot slower, delivering its medicine some hours later and at a slower rate. The effect is that the patient receives a continuous level of medication through-out the day.
Intuniv has not yet been given full approval by the FDA. In a recent press release, Shire stated that a 25% reduction in ADHD symptoms were seen in children compared with a placebo. This sounds good but remember this against children receiving no treatment. How effective it is versus Adderall XR or non-medical interventions has not been measured. It is also worth remembering that Shire PLC are selling Intuniv and will therefore be putting the best possible spin on their results. Independent researchers often find that real-world results do not match up to the drug company’s trial results.
Unlike most other ADHD medications, Intuniv is not stimulant based and is not a controlled substance. This means it has no potential for abuse in the way that Ritalin etc have. This should mean the drug is safer to take for long-periods of time but there has been no research in this area.
Unfortunately the story with side effects is not so good. Over 80% of children using it ireported adverse events (medical problems) during the 20 day trial. Most are unconnected to the drug and represent the normal childhood health problems but only 71% of users on the placebo had adverse effects. This is a significant difference and clearly shows that Intuniv has health risks. Adverse events reported include somnolence (32 percent), headache (26 percent), fatigue (18 percent), upper abdominal pain (14 percent) and sedation (13 percent) plus constipation, dizziness, dry mouth, hypertension and sedation. Shire PLC describe these as non-serious problems and highlight that fractionally less children on the drug developed serious problems compared to the placebo.
Can you match ten drug safety warnings to their drugs?
“Vision changes, such as seeing a blue tinge to objects or having difficulty telling the difference between the colors blue and green.” Also, “An erection that won’t go away”
“Babies born to mothers who have taken [this drug] in the latter half of pregnancy have reported complications, including difficulties with breathing, turning blue, floppiness, stiffness, irritability or constant crying.”
From Mental Floss
Using the Myomancy blogroll and a few other tools I trawl the internet for references to dyslexia, ADHD and everything related. Generally I find nothing of interest but its like beach combing. Amongst all the flotsam and jetsam, something useful occasionally turns up. On a recent search I came across a reference on a blog that I would not normally link to from Myomancy but because they touched on an important issue I will. Its People Having Sex, a Not Safe For Work adult blog, that was looking at Drugs & Sex. One of the drugs they mentioned was Ritalin.
Methylphenidate (Ritalin) is widely used both legally and illegally. It apparently causes increased or decreased sexual desire dependent on the dosage. At higher doses, it may aggravate premature ejaculation and impotence and cause anxiety
On ADHD fourms (such as ADD Forums) you often find people taking ADHD medication and talking about sexual dysfunction (such as this thread). It seems to be quite a common problem but because most studies are done on children, it isn’t well documented. See Concerta Side Effects, Ritalin Side Effects and Adderall Side Effects for more information on ADHD medication side effects.
The only work I can find on the issues is The Management of Medication-Induced Sexual Dysfunction [ PDF ] which in turn references Methylphenidate and SSRI-Induced sexual side effects. Unfortunately that study is not available online.
The effects that ADHD medication like Ritalin and Adderall have on sex drive and sexual performance is real and is highly disturbing for those it effects. It is an area where more research it definitely needed.
Long time reader Mary sent me details of a study on how legal and illegal drugs effect the developing brain. The results suggest that Delta FosB, a brain chemical that is linked to addiction, greatly increases. However this only happens in adolescent brains, not in young or older brains. This highlights both how adolescent brains far more plastic and subject to change than adult or child brains.
See Jefferson Scientists Find Evidence Of Greater Sensitivity To Addictive Drugs In Adolescence for a write up of the study or Periadolescent Mice Show Enhanced Delta FosB Upregulation in Response to Cocaine and Amphetamine for the original study.
Mindhacks has an interesting post on how Ritalin prescriptions increase when parents divorce.
Drug companies and some charities have invested a lot in selling the idea that ADHD is a purely neurological disorder and that the child’s family life has little to do with it.
This study suggests that this isn’t the case, and that the child’s environment and relationships, in combination with possible genetic and neurological differences, have a significant effect on their behaviour.
Vyvanse is the new ADHD medication from Shire PLC, the makers of Adderall XR. It marks a significant change in the range of medication available as it uses a different type of stimulant than other medications, it a has long duration and it is especially formulated to prevent substance abuse.
The active substance in Vyvanse is lisdexamfetamine and is chemically very close to Dexedrine Spansules, a stimulant occasionally prescribed for ADHD. The advantage of lisdexamfetamine over methylphenidate (used in Ritalin and Concerta) is that it has a long lasting effect. Taken in the in the morning, the peak effectiveness last one to four hours but had a notable effect on symptoms for 12 hours.
Traditional ADHD medications have been easy to abuse and this has led to dependency problems. Vyvanse is a prodrug, a substance that is inert until it is digested. This mimics how the body creates useful chemical and vitamins from our food. As Vyvanse only acts as a stimulant once it is broken down by the stomach you cannot get a high from grinding it up and snorting it. Swallowing higher than prescribed doses (150mg compared to the recommend max of 70mg) will still produce a high indistinguishable from that produced by a comparable dose of Ritalin.
Because Vyvanse is new it has only been used by those adults and children who took part in the drug’s trials. In total, less than 1000 people. With such a small sample (compared to the millions who will end up taking the drug) there is very little first hand knowledge of the drugs effects. With each of the other major drugs, Ritalin, Adderall etc, different people can have very different reactions to the drugs. Someone who is fine on one drug may have numerous side effects from a chemically very similar drug. The body and brain are very complex chemical systems and stimulants are a very crude tool.
Currently we only have the Vyvanse prescribing information to go on as a guide to its effects but one things is very noticeable. In trials 10% of users stopped taking the drug due to adverse effects (i.e. side effects). This is much higher than Adderall where only 2.4% of participants were effected. In the Adderall trials more people stopped using the placebo than the real drug but for Vyvanse only 1% of placebo users dropped out. The new drug has a side effect rate 10 times higher than the base line and four times high than Adderall.
Shire PLC are introducing this new drug as a replacement for Adderall XR whose patent is running out. They hope to capture 50% of the market share with the drug and as the market is worth $3 billion, a 50% share will generate a lot of money. Expect to see a lot of advertising aimed at parents, not doctors, when Vyvanse is launched in July. In theory Vyvanse is a lot cheaper to make than competing drugs as its chemical formula is its key rather than the complex release mechanisms used by others drugs. However I expect that Vyvanse will retail at about the same as the other ADHD medications at about $130 – $150 for a months dose.
Vyvanse, a new ADHD medication has just got approval from the Drug Enforcement Agency (DEA) who classified it as a schedule II controlled substance, the same class as Ritalin, Concerta and many street drugs. This is the final step before Shire PLC can launch the drug commercially. Shire also Adderall, and Adderall XR.
The new drug has been formulated to provide both the long-lasting effects of Adderall XR and to minimise the potential for abuse. ADHD medication are strong stimulants and can be open to abuse both by those it prescribed to and by those who acquire it illegally.