Psychotropic Drugs

 

“Stimulants do not produce lasting improvements in aggressivity, conduct disorder, criminality, education achievement, job functioning, marital relationships, or long-term adjustment.”      --APA’s Textbook of Psychiatry, 1994

 

Stimulants are highly effective in “dramatically reducing a range of core ADHD symptoms such as task-irrelevant activity (e.g., finger tapping, fidgetiness, fine motor movement, off-task during direct observation) and classroom disturbance.”  --NIMH investigators in 1995

 

One of the greatest risks of stimulants is that it will repress autonomous, spontaneous, social, playful behavior and will bring compliance, docility, obsessive, rote behavior. Major adverse reactions include permanent CNS damage and persistent brain dysfunction.     --Peter Breggin M.D. (1999).  Psychostimulants in the treatment of children diagnosed with ADHD: Risks and mechanism of action. Int’l Journal of Risk & Safety in Medicine, 12, 3-35

 

Multimodal Treatment of ADHD - NIMH (1999)

  ‘I think we exaggerated the beneficial impact of medication in the first study. We had thought that children medicated longer would have better outcomes. That didn’t happen to be the case…In the short run [medication] will help the child behave better, in the long run it won’t.  And that information should be made very clear to parents.’  - William Pelham Ph.D.

At end of 14 months, “carefully crafted medication management” had proven to be superior to behavioral treatment in terms of reducing core ADHD symptoms. There was a hint that medicated children also did better on reading tests.

At the end of 36 months, “medication use was a significant marker not of beneficial outcome, but of deterioration. That is, participants using medication in the 24-to-36 month period actually showed increased symptomatology during that interval relative to those not taking medication.” Medicated children were also slightly smaller, and had higher delinquency scores.

At end of six years, medication use was “associated with worse hyperactivity-impulsivity and oppositional defiant disorder symptoms”, and with greater “overall functional impairment.”

Sources: The MTA Cooperative Group, “A 14-month randomized clinical trial of treatment strategies for attention deficit/hyperactivity disorder”, Archives of General Psychiatry 56 (1999):1073-86.  Jensen, “A 3-year follow-up of the NIMH MTA study”, J Amer Academy of Child & Adolescent Psychiatry 46 (2008):989-1002. Molina, “MTA at 8 years,” J Amer Academy of Child & Adolescent Psychiatry 48 (2009):484-500.

“The findings . . . were not consistent with views and expectations about medication effects held by many investigators and clinicians in the field. That is, long term benefits from consistent treatment were not documented; selection bias did not account for the loss of relative superiority of medication over time; there was no evidence for “catch up” growth; and early treatment with medication did not protect against later adverse outcomes.”

Source: J. Swanson. “Evidence, interpretation and qualification from multiple reports of long-term outcomes in the multimodal treatment study of children with ADHD Part II.” J of Attention Disorders 12 (2008):15-43.

 

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Drug Effectiveness Review Project (Oregon Health and Science University, 2005)

In a review of 2,287 studies:

¨  There is “no good quality evidence on the use of drugs to affect outcomes relating to global academic performance, consequences of risky behaviors, social achievements, etc.”

 

 

Source: McDonagh, “Drug class review on pharmacologic treatment for ADHD,” 2006. http://www.ohsu.edu/drugeffectiveness

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In February 2010 a review of information from the Raine Study, a longitudinal study of the health and wellbeing of thousands of Western Australian children, provided the world’s first long term (8 year) data on the safety and efficacy of ADHD stimulants. It provided challenging evidence that amongst children diagnosed with ADHD those ‘medicated’ with stimulants had significantly worse outcomes than those ‘never medicated’.

         Source: Western Australian Department of Health, “Raine ADHD study: Long-term outcomes associated with stimulant medication in the treatment of ADHD children,” 2009.

¨  Medicated ADHD children were 10 times more likely than unmedicated ADHD children to be identified by teachers as performing below age level.

¨  A small effect size showed worse ADHD symptoms in the medicated group

¨  Medicated children had elevated diastolic BP

¨  Conclusion: Medication does not translate into long-term benefits to the child’s social and emotional outcomes, school-based performance, or symptom improvement.

 

 

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Study of Long-Term Outcomes in Quebec

¨  “The increase in medication use is associated with increases in unhappiness and a deterioration in relationship with parents. These emotional and social effects are concentrated among girls, who also experience increases in anxiety and depression. We also see some evidence of deterioration in contemporaneous educational outcomes including grade repetition and mathematics scores. When we turn to an examination of long-term outcomes, we find that increases in medication use are associated with increases in the probability that boys dropped out of school and with marginal increases in the probability that girls have ever been diagnosed with a mental or emotional disorder.

Source: J. Currie. “Do stimulant medications improve educational and behavioral outcomes for children with ADHD?” NBER working paper 19105, June 2013.