Rats and Ritalin -- results=depression, stress

[catatonic]

Researchers are FINALLY beginning to do some long-term research on the effects of stimulant medication. Thus far only in rats, but it's a step in the right direction. Some of the results from 3 recently published studies:

"Rats exposed to Ritalin as juveniles showed large increases in learned-helplessness behavior during adulthood, suggesting a tendency toward depression"

"A team at the University of Texas Southwestern Medical Center at Dallas found that adult rats were less responsive to rewarding stimuli and reacted more to stress if they had been given methylphenidate as youngsters. "

The rats also showed a reduced inclination to eat cocaine, a substance they normally love.

If you want to read a CNN summary of the studies, go to www.cnn.com/2003/HEALTH/parenting/12/08/add.drugs.reut/index.html

[Dad2Brooke]

catatonic, thanks for the link. I read the article on CNN website. It's definately something to think about.

Of course the whole medicate - not medicate issue is difficult enough. I think even without the study, parents worry about the long term effects on their youngsters being on meds, versus the long term affects that untreated ADHD will have on their childrens lives.

It also mentioned that, obviously, rats are different than humans.

Another thing, I was wondering about. Did those rats have ADHD or the equivalent to it in rat terms. Playing the devils advocate here, if they didn't have ADHD, how do we know that the results would have been the same if they did?

[GSDMommy]

D2B brings up some cogent points, I had a couple of other thoughts as well:

1) what dosage were the rats on? Was it the equivalent amount as a child would be given?

2) the article said this:
"One of the changes seems good. Early exposure to Ritalin makes rats less responsive to the rewarding effects of cocaine. But that's not all good. It might mean that the drug short-circuits the brain's reward system. That would make it difficult to experience pleasure -- a "hallmark symptom of depression," Carlezon and colleagues note"- MIGHT is a big word.

3) Is the medicating of a child the lesser of two evils? I have children who have run out in front of cars and engage in life threatening behaviors. To me it is better to medicate and have the child around to learn the coping skills to deal with the ADHD and then see if they can go off it eventually.

4) the article I was sent was from WebMD and I would be willing to bet all those who have dissapproving family members and friends are being sent the same article!! I would be interested to see the results of the study and those that should come after it. Unfortunately, if the results come back less than alarming or even that it is safe, we won't see it because that result isn't as eye-catching as results like this. News reports what catches your attention, not necessarily the unvarnished truth.

[catatonic]

I don't think there is any "unvarnished truth" as far as ADHD is concerned. Nothing works for everyone and there are plenty of drawbacks to every type of treatment. It's why we're all here -- because there are no easy answers or foolproof solutions. But to me this research...indeed, all of the research on stimulant usage...raises a very large and disturbing question:

Why is there no data on long-term effects of stimulant use among children?

It's not as if these are new medications. They've been in use for 30 years now. Drug companies never hesitate to fund studies that work to their advantage. They have the deepest of the deep pockets. The fact that there IS NO LONG-TERM DATA makes me deeply suspicious and extremely uneasy. One of the reasons I have chosen not to medicate my son is concern over the lack of long-term studies. So I'll be looking for follow-up studies as well.

[Kymn]

catatonic,you are incorrect in some of your statements,the use of Ritalin has actually been over 50years not 30 and there are long term studies on it with positive results.For every negative study you find I could find you 3 or 4 that are the exact opposite.I dont think there are many of us on the board who have taken this decision lightly and who have not done our homework thusly making the decisions we have made.I respect your decision to not help your child with the use of medication but no more than I respect those on the board who choose to use it.We are all here for the purpose of helping our children be the very best we can be and your continual negative comments on the board about the use of medication I am sorry but I really find counter productive.I get enough critisism from those out there who no nothing about dealing with ADHD I certainly dont expect to get from those who are living it regardless of there choice on how to deal with it.Please know that I am not writing this to anger you but to let you know that some of your comments are quite hurtful and do not make me change my mind on my decision to medicate they just make me sad that you cant respect the decision I and many others have made.Please consider this we are all parents doing the best we can
sincerely
Kymn

[AustinsMom]

As someone who has used meds, but now doesn't, I have struggled through both sides of this issue. And I know that even though I decided that medicine was the best option for my child, I still felt worried about using it. And perhaps that's why Catatonics concerns are upsetting; they create doubt in your mind that what you are doing is the best thing. But I agree that all parents here have looked at their child's abilities and needs and searched for the best option for their child, have not made the decision lightly, and are doing what they think is best for their child at that particular time.

But I also see that Catatonic is very passionate in her concern that meds are not healthy for children, and is just trying to sound a warning alarm. I know that after our experience with Strattera, I keep wanting to warn parents using it to keep a watchful eye for side effects, cause I don't want them to be caught off guard and for their child to have the trouble that Austin had.

I feel that the jury is still out on what works best for ADHD treatment and we as parents have got to read and consider everything--even if it doesn't match what we are currently doing. Educating ourselves about all options including benefits and risks, will only help our children in the long run. It's our differences that make this board unique and give us all different perspectives to consider.

[catatonic]

Kymn, I'm sorry that you interpreted my information as some kind of a personal condemnation. Believe me, it was not intended that way. I recognize how difficult these decisions are for everyone concerned. I feel just as strongly that aspartame is unhealthy and dangerous, but am rarely attacked by diet soda drinkers for holding that opinion. Honestly, I'm at a loss what you found hurtful in this post, which basically only expresses a desire for more information.

I'm sure not alone in that desire. Most of the "experts" agree that there's a problem. Even the Journal of Attention Disorders acknowledges the lack of long-term data in its recent article "40 Years of Methylphenidate Treatment in ADHD" ( www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12685516&dopt=Abstract )

Another recent article in the same journal was a literature review of the "long term" methylphenidate safety data. They classified "long term" as any study with a duration of more than 12 months. The longest term found was 18 months. and there were only 6 of these studies.

One study claiming to be long-term administered Ritalin for an 8-week period, then did 6-month follow-ups for a two-year period. This is not the same as administering Ritalin for a 2-year period. Many, many children take these medications for years.

A study of mentally retarded ADHD children (published in Journal of Abnormal Psychology August 1997) found that 5 years later, more than 2/3 of the original sample of 52 children continued to be prescribed methylphenidate, and that 2/3 of these remained at the 98th percentile of hyperactivity indexed behaviors.

Additionally, these studies look only at "side effects" as in behavioral outcomes. They do not pay attention to permanent changes in brain physiology, which initial investigations indicate may occur with methylphenidate use. (see www.abc.net.au/science/news/stories/s414363.htm )

In France, just to give one example, they regulate Ritalin very closely and a recent issue of the conservative journal "Therapie" (April 2002) once again cites lack of long term data as an important reason for keeping these regulations in effect and recommends their adoption by other countries.

The sentiment is echoed in Swedish journals ( www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11887717&dopt=Abstract)

None of this means that people who medicate their children are bad, or that the medications are bad. If my child needed chemotherapy, he'd get it, despite nausea and hair loss. But I'd certainly familiarize myself with side effects, potential dangers, and watch very closely for problems. I don't see Ritalin as any different from any other medication. You have to use them with respect. And if that means facing the fact that they may do harm in the process of doing good, then I'd want to know as much as possible about what the research has shown as well as what it's failed to show.

On the original rat research, Dad2Brooke, you're correct that the rats did not have the rat version of ADHD. Is there a rat version of ADHD? Interesting question. I'll be looking into that.

For GSDmommy - the rats were taking the rat equivalent of a high pediatric dose of Ritalin. If you look at some of the data on other neurologically active substances (MSG, for example) it appears that the human brain (particularly a child's brain) is far, far more sensitive to these substances than are rat brains. With most neurologically active chemicals, you can expect a greatly exaggerated effect on children's brains.

(The book "Excitotoxins" by Russell Blaylock contains a wealth of fascinating data on neurologically active chemicals. I highly recommend it. You need no specialized or technical knowledge to understand and enjoy it.)

Is medicating the lesser of two evils? Well, I don't think medications are evil, more of a double-edged sword. Certainly for a child who has become a danger to himself or others, there is little option. Under those circumstances, I would medicate my own child, at least short-term.

Do you find that friends and family are critical of your decision to medicate your child? I've found the opposite, that they are critical of my decision not to medicate. Family, anyway. My friends are so supportive that it really touches my heart and makes up for my stubborn relations.

[Kymn]

Cat yes I agree that we need to educate ourselves on the positive and the negative consequences of medication. I guess I just felt a little judged by you because all of your posts that I have read come across as so negative towards meds I apologize if this is not the case.I get tired of defending my decision and perhaps I took it out on you again sorry My parents are supportive but I do get alot of neg from casual friends which I should just ignore I know.You really do need to balance the positive as well though and I just dont feel you do that but I do acknowledge I could be wrong
Kymn

[catatonic]

Kymn -
You're right in that I generally don't try to balance the positive with the negative of medications. This is not because I make any kind of judgment of people using meds, or even of the meds themselves. It's simply that we're bombarded with pro-medication information. It comes from doctors, from schools, from advertising in magazines and television and every other place. The benefits of medication have been more than adequately explored...and I'm certainly not denying that there ARE benefits.

What you won't hear about from any of those sources are the children forced to withdraw from the Adderall studies because of dangerous and uncontrollable rages, or the FDA statement that methylphenidate shows mild tumorgenic properties. Or any of the research showing that there are EFFECTIVE non-medication options for treating ADHD.

I want people to know these things, particularly that there are alternatives. It's critically important that parents know this. Who else is going to tell them? I guarantee you won't hear about it from the school counselor or your pediatrician.

We all do what we believe is best for our children based on the information available to us. I just want to make sure that information is more balanced. Despite the fact that it's just a useless little drop in the bucket in the face of massive pharmaceutical advertising campaigns and the often overwhelming pressure from schools and physicians.

[finnmom]

Cat
I´ve been reading this thread with a cold ring around my heart We have decided to start giving Conserta for ds8. That really freek´s me out ;D I dont know what to think

Here in Finland we have a little bit different situation than in U.S Here it´s very hard to get an prescription for child, it tooked us 1½ before it was even considered. Now when we are starting, we got very strick order´s to use ONLY on schooldays, have a total bloodscheck done every 6 month´s, we have an prescription only for 6 month´s at time. The neurologist told us that using this med is supposed to continue max 2-3 year´s no wurther. thank you for starting this, and thank´s for all those who replying,I need this info
Marja

[catatonic]

Marja -
I'm very interested in how the medication issue is handled there. If it took you so long to obtain a prescription for Concerta, were there other treatments that you tried while waiting? If doctors aren't able to prescribe medications as freely, what else do they recommend that you do?

Do you know if these meds are so carefully regulated because of concerns about addiction, or because of concerns about their effects on children's health, or because of some other reason?

I don't mean to bombard you with questions, but this is a very, very interesting subject to me. I'm glad to hear that these medications are treated with the seriousness they deserve, and yet that they remain available to those who need them.

I'm sure this must be a difficult time for you as a mom starting with the medication. Wondering if it will work like you hope, watching to make sure it is working safely. I hope that all goes well for you and your boy.

[GSDMommy]

"For GSDmommy - the rats were taking the rat equivalent of a high pediatric dose of Ritalin. If you look at some of the data on other neurologically active substances (MSG, for example) it appears that the human brain (particularly a child's brain) is far, far more sensitive to these substances than are rat brains. With most neurologically active chemicals, you can expect a greatly exaggerated effect on children's brains." - Catatonic

You can have a greatly exaggerated effect on any population. Sensitivities aren't just age based. There was no data I found to suggest the dosing they gave the rats was equivalent to the pediatric dosing. Additionally, another thing to look for is: who is funding the study? This can greatly effect the outcome's phrasing and presentation.

" Do you find that friends and family are critical of your decision to medicate your child? I've found the opposite, that they are critical of my decision not to medicate. Family, anyway. My friends are so supportive that it really touches my heart and makes up for my stubborn relations. "- catatonic

I find anyone will be critical of parenting when your children are being observed. Parenting is the only profession where there is no universal right way to go, but everyone has an opinion. No one lives our lives or has our decisions. Medications are a touchy subject anyway. There have been longitudinal studies on all of these meds, but we are the best judges of the efficacy of them for our children. You wouldn't want my whole crew for a weekend without any meds. If you did medicate, you would find people against that as well. There are many pros and cons and we, as parents, are the ones to weigh them carefully. Not popular opinion, or somebody who has experienced success with their own child using vitamins or whatever telling you that that is the "cure" and you are "bad" for using medications. I am not implying you are doing this, I have just had rabid parents do this to me before. Informing me is good, yelling and juding me is bad.

Sensationalizing the possible effects of medications isn't necessary. It is news, they do what they can to get our attention. Interesting article I found about a long term < 2 year> study of methylphenidate:

www.nimh.nih.gov/events/adhdworkshop.cfm

[finnmom]

Catatonic
I try to answer your question´s. Med´s are considered as the last of last option´s. Before they´ll give the prescription, there has to be , in our case, 2 different evaluations by psychologist, an neuropsychologist and finelly an neurologist appoinment, they also tooked the EEG, just for case. The EEG is taken as an basic "out-ruling" test for every ADHD-child(Epileptic etc.)

At the very first they wrote an decision that my son need´s an personal assistant in school, if the small-group is not possible. My son got to the smaller group with only 6 children and theacher and assistant. then there is OT, what my ds get´s once a week and we got directions for behaviour modification(?). But other than that, there is nothing . I have to add, that my son is a mild case of ADHD and untill this fall this seemed to be enough. now there has been problem´s in concentraiting and moving from task to an other,so we needed to try this.

Here the policy in this is that med´s are used only at schooldays, and that 2-3 years is maximum, as i propably already wrote ;D

I got the idea that they are so uneasy with med´s because almost all of the reasons you gave. they want to prefent even the possibility of addiction, are very conserned about healt-reason´s, expecially lever-factor´s and about what problem´s might came with long term use. Also these med´s, atleast Ritalin, is concidered as an drug, it can only be prescribed with an drug-prescription.

This was our first day, so i have no opinion yet, but hopely....
I hope this answers to your question´s!
Marja

[catatonic]

Marja - thanks for answering my questions. I think a class size of 6 with teacher and assistant sounds ideal and wish it were available here. My boy has 23 in his class, just a teacher. Too many distractions. By the way, I have a good friend with an ADD daughter (without the "H"), who is 9 and taking Concerta since summer. She has been completely happy with its success and says the only side effect she's seen is that her girl has lost some weight. Her grades are good again and she doesn't "space out" any more. She's told me several times that if I ever decide we need to add meds, Concerta is definitely the way to go. So there's one rave review to help put your mind at rest.

GSDmommy - the NIMH seminar you linked to looks like it must have been really informative, and I'm glad to see that the scientific community is joining in the call for increased long-term research. NIMH has put its money where its mouth is and begun funding a number of more in-depth studies on ADHD medications...their effects on brain physiology as well as longer-term behavioral impacts.

From the NIMH article:
"Summary: Discussions clearly indicated an immediate need for more focused research to examine the long-term consequences of therapeutic stimulant administration in children. One positive outcome of this workshop for basic neuroscience will hopefully be the initiation of studies to examine the beneficial as well as negative effects, and the potential long-term risks, of chronic stimulant medication used to treat ADHD in children."

Safe to say the basic neuroscience community views the new influx of federal dollars as top on the list of positive outcomes. Luckily, it's something we can all benefit from.

The National Institute of Health remains consistent in its endorsement of stimulants as the most effective (and generally safe) way of treating ADHD:

"Three medications in the class of drugs known as stimulants seem to be the most effective in both children and adults. These are methylphenidate (Ritalin), dextroamphetamine (Dexedrine or Dextrostat), and pemoline (Cylert). For many people, these medicines dramatically reduce their hyperactivity and improve their ability to focus, work, and learn. "
www.nimh.nih.gov/publicat/adhd.cfm#adhd10

On the original research mentioned...William Carlezon is a Harvard Med professor, and there is more specific info on experimental methodology through the teaching hospital's website. ( www.mcleanhospital.org/PublicAffairs/20011202_ritalincocaine.htm )
He is quoted there as saying: "It looks like Ritalin might change the brain forever," said Carlezon, director of McLean Hospital’s Behavioral Genetics Laboratory. "We have to be ready to deal with the consequences of that."

Dr. Carlezon presently is working under a pair of grants from the National Institute of Health (NIH, 100% fed funded), although previous research was funded by the National Institute of Mental Health (NIMH, also fed).

Medications are a touchy subject anyway.

I've kinda noticed that, too.

[Veronika]

There have been ongoing debates about meds and our children for years. I believe it up to the parents to know what is best for their kids. If it works, and the child feels better, then try it. If you see alot of unwanted side effects, than stop giving them the meds. Meds work differently for everyone....some people can tolerate them and some people can't.

I've been perscribed Ritalin to help treat my Adult ADD. I don't feel like a rat