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Saturday, March 12, 2011

How do I know if my teen needs ADHD (ADD) meds?

The safety of ADHD drugs is complicated because there are many issues that prevent the public from knowing the truth. For example, pharmaceutical companies are not required to publish studies about their products when they show no effect or a negative effect. In fact, up until 2008, over 40% of the studies conducted on anti-depressants (SSRI's) were not available to the public or to doctors.

This is a typical story that I experience in my mental health private practice; it represents the darker side of ADHD medications, and unfortunately, it's much more common that you might be willing to believe. Several years ago, a high school student, came in for an appointment (I'll call him John*). John's parents told him that they "couldn't help him anymore," and that he "needed to figure things out," and "get help." John's grades had slowly declined since his Freshman year, and now, he was nearly failing three classes.  

He said his parents suspected 
that he might have ADD.

Teenagers who complain of attention problems
may be seeking ADHD drugs to abuse or sell or
they may be suffering from marijuana induced
attention and memory problems.

John had told me that he "just can't concentrate in class." He had answered "yes" to almost all the questions on the ADD screening. John had thought that I could prescribe him medications. I explained that, even if I could, I wouldn't do so until he thoroughly tried other alternatives and involved his parents in the therapy. In between our meetings, he went to see a psychiatrist who prescribed him Adderall.  At the end of the semester, John's grades remained poor. He failed one class and had D's in most of the others. Regardless of taking Adderall, he continued to avoid doing homework and he did poorly on most tests.

UPDATE: Marijuana appears to cause anatomical changes in brain of teenagers who use it just once a week or more.

Did John really have ADD? No. It turns out that John was 
abusing drugs and his latest preference was for amphetamines. 
Adderall wasn't the only drug that John was abusing. He had tried Cocaine, Marijuana, and he also abused Alcohol, at night in his bedroom, to "wind down" after taking speed all day. He liked Adderall because it was "legal" and "safe," or so he thought. John wasn't willing to share this information with me until many months into therapy. He was worried that I would tell his parents or the police. He also was worried about me judging or criticizing him.

John was a fine student until his Sophomore year
  of High School. However, he never learned to work hard
because things had come easy for him until he was 14. 

Like many teens, when John was 12, his relationship with his parents began to suffer. Their communication had broken down and with that his sense of connection. He was socially anxious and ended up making friends with the "wrong group of kids." That's when things really started to slide downhill. 

The issue of faking ADD symptoms to get Amphetamines is probably more common than many parents think. It is embarrassingly easy for someone to fake ADD symptoms in order to get a prescription of Adderall or other stimulant drugs. 

Since the FDA has allowed pharmaceutical corporations 
to market their drugs with cute or melodramatic commercials, 
prescriptions of psychotropic drugs have sky rocketed. 

Adderall, though legal by prescription, is gram-for-gram, 
just as potent as Cocaine - and can be just as dangerous

All amphetamines can cause serious spikes in blood pressure which can cause stroke, arrhythmia and sudden death. Amphetamines are psychologically addictive, but not physically addictive. Although, through research we have learned that psychological addiction is a form of physical addiction that occurs in the physiology of the brain - so, it's real, not just "all in your head," as people still say.

ADD symptoms are easy to fake. But, the problem is that some doctors are not taking enough time to properly determine the cause of the ADD symptoms. It's easy to describe someone's symptoms in terms of a syndrome, such as ADD or depression, but it takes much more time to determine the cause of the syndrome. It is also to important to rule out substance abuse problems, depression, anxiety, and other issues.

Doctors treat mental health syndromes, like ADD, the same way they treat cancer - using chemotherapy, which is another way of saying, chemical therapies. There's no such things as a chemical imbalance. For example, cancer is caused by many factors interacting with each other and chemotherapy can help destroy the cancer cells. Does that mean that cancer was caused by a chemical imbalance?

This chart from the National Institute of Health, shows how similar Meth is to Adderall on three scales according to the users who took part in the study (amph is adderall, ma is meth amphetamine). Keep in mind that Adderall can be inhaled which dramatically increases its effect and addictive potential.

ADD may be treated with Amphetamines, but again, 
that does not mean that it was caused by a chemical imbalance.

It's so important for parents to be aware that ADD is just a syndrome. In other words, the symptoms of ADD may have one or many causes and medication may not be the best intervention, and sometimes it can be the worst. Also, contrary to what you'll find on internet mental health sites, there is still not a preponderance of scientific evidence that ADD is genetically transmitted.

Teenagers seem to have very easy access to a host of drugs regulated by the FDA and DEA.
The drugs are safer than street drugs in that they are not "cut" with other harmful substances like formaldehyde, talc, lead, or other poisons. They are also free because insurance or parents pay for them.

Here are some examples of symptoms that teens have faked in order to acquire drugs:
1. "Pain" in order to get opiates like Codeine, Vicodin, Percoset, or Oxycodone.
2. "Anxiety" in order to get benzodiazapines like Valium, Xanax, or Klonopin.
3. "Poor concentration," in order to get amphetamines like Adderall, Dexadrine, or Ritialin.

It is my guess that teens are abusing prescription drugs more often than street drugs. Teens also have access to their parent's pills, and in America, parents are being prescribed these types drugs in record numbers. Keep in mind that I'm not putting ideas out there for teens. These are what teens are telling me is going on and I'm just reporting it. Many teens are willing to talk about Marijuana or alcohol abuse with their parents, but they wont discuss these other drugs. In teen circles, it seems almost taboo to talk about prescription drug abuse.

ADD is diagnosed all too often and medications are prescribed way too easily. Many doctors do not take the time to give an Informed Consent to parents or teens about the potential side effects of psychotropic drugs. Amphetamines are very serious medications to take short or long-term. Mixing Amphetamines with sedatives or hypnotics, like alcohol, Valium, or Lunesta can be lethal. Mixing Amphetamines with SSRI medications like Lexapro can cause Serotonin Storm, which can also become fatal.

It may come as a surprise to parents, but the cause of ADD 
is not scientifically known. 
Read this post here for information about
what exactly is ADHD or ADD.

There are hypothesis about the cause, the primary idea is that there's not enough Dopamine in certain areas of the brain. However, the syndrome of ADD can be caused by Anxiety and Worrying, by OCD, by GAD, by poor parenting, depression, by poor parent-child relationships, by poor sleep, by poor nutrition, by excessive video game playing, by exposure to toxins, by developmental delay, and other factors known and unknown.

It's not normal for a teenager to develop or first become aware of attention problems in high school. Teens who report or allege that they are having difficulty paying attention are likely to have something else is going on, such as depression, adjustment disorder, an anxiety disorder, relationship problems, bullying, substance abuse, sleep problems, or other issues.

ADD is probably a developmental disorder where symptoms will be seen in early childhood, and it will significantly impact the child's academic performance. Special parenting techniques can dramatically improve behavior in many children with attention problems. There are alternatives to medications that should be the first line of treatment, not the last.

ADD should be diagnosed carefully and other causes of attention problems should be ruled out. Medications should be given with caution with monthly monitoring of goal progress.   Parenting and Family therapies should be given as a first line of treatment for ADD., especially with teenagers and adults. Complaints of late-onset ADD or Adult ADD should be viewed with skepticism and alcohol and substance abuse histories should be assessed.

Mental Health Advice Disclaimer: The information included in this post and blog are for educational purposes only. It is not intended nor implied to be a substitute for professional mental health treatment or medical advice. The reader should always consult his or her mental health provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a mental health or medical condition or treatment plan. Reading the information on this website does not create a therapist-patient relationship.

*The information in this scenario has been substantially changed in order to protect the privacy of patients. It is common for medical providers to discuss the anecdotes of patients so long as their identity is thoroughly concealed.

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