Critical Psychiatry Textbook, Chapter 9: ADHD (Part Three)

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Editor’s Note: Over the next several months, Mad in America is publishing a serialized version of Peter Gøtzsche’s book, Critical Psychiatry Textbook. In this blog, he discusses the harms of ADHD drugs. Each Monday, a new section of the book is published, and all chapters are archived here.

Harms of ADHD drugs

The information on harms of stimulants was inconsistent and the most important harms received little or no attention in the textbooks.

Among the listed harms were headache, dry mouth, nausea, stomach pain, tics, irritability, sadness/depression, nervousness, worsening of anxiety symptoms, sedation, increased blood pressure in 5% of the patients, insomnia, anorexia, and possibly weight loss.16:475,18:229,18:244,19:117 One book regarded anorexia as the likely cause of a reduction in height of 2 cm,19:117 which is speculative.

The harms were said to be frequent but often reversible. The readers were not told which harms are not reversible. 18:229,19:117

One book mentioned the potential for drug abuse.18:229 Indeed, and ADHD drugs are easily available on the black market. This book noted 15 pages further ahead that, in rare cases, the drugs can cause arrhythmias, palpitations, mania, or psychosis.18:244 It did not mention reduced height and weight, even though they are irreversible harms, or misdiagnosis of bipolar due to adverse effects of the drug, which is also pretty irreversible, or violence.401 The book did not mention the MTA study, but in a section called “Abuse and dependence on illegal drugs,” the book noted that stimulants include cocaine, “amphetamine (speed),” and methylphenidate.18:76

Thus, this book did not hide that ADHD drugs can be abused. It also noted that abstinence reactions could include depression, and that some people become depressed after a few doses of stimulants, which the authors believed, with no references, was likely because of the drugs’ effect on the brain’s serotonin system.

This is one of the extremely few instances where a textbook admitted that a psychiatric drug can harm the brain. But as always, the authors were so absorbed in the drug focused paradigm that even though they noted that the depressions could come suddenly, be long-lasting, and cause a great risk of suicide, they did not advice tapering of the offending drug but that the depression can be treated with depression pills.18:76 This advice is deadly, as it will increase suicides.

A third book listed only anorexia, insomnia, and cardiovascular harms under adult ADHD,17:618 but 48 pages further ahead it listed some more harms and stated that the most common ones were insomnia, anorexia, headache, weight loss, dry mouth, mood swings, and an increase in blood pressure and pulse.17:666 The book noted that the drugs can cause mania, worsen tic diseases and destabilise bipolar disease, but not that bipolar is often misdiagnosed because of the drugs’ harms.

The only mentioning of withdrawal symptoms I found was in a book that noted that the symptoms can lead to decreased ability to drive, use machines, and work.19:118

Death, the most severe of all harms, was not mentioned in any of the textbooks even though sudden death, stroke, and myocardial infarction are listed on the first page in the package insert for methylphenidate.34

Adderall—a mixture of amphetamine salts—was a weight reduction drug called Obetrol, which was so addictive that it fell into disrepute and was withdrawn from the market.538 This drug is now being sold in USA to children with an ADHD diagnosis. It was withdrawn in Canada in 2005 after 14 children suddenly died and two had strokes.539 The FDA did nothing, apart from trying to convince their Canadian colleagues not to withdraw the drug.

Children have killed themselves or suddenly dropped dead while playing with friends.261,401 Psychiatrists writing textbooks do not think this is important information.

These addictive drugs are stimulants and work like amphetamine; in fact, some of them are amphetamine. WHO describes amphetamine-type stimulants, including methylphenidate and MDMA (ecstasy) this way:540

“Over the past decade, abuse of amphetamine-type stimulants (ATS) has infiltrated its way into the mainstream culture in certain countries. Younger people in particular seem to possess a skewed sense of safety about the substances believing rather erroneously that the substances are safe and benign … the present situation warrants immediate attention.”

It is hardly surprising that young people think these substances are safe, as so many of their friends get them on prescription.

Crystal meth is the common name for crystal methamphetamine, a strong and highly addictive drug. In 2017, about 0.6% of the US population reported having used methamphetamine in the past year.541 The usage of stimulants on prescription was 0.8% of the Danish population, also in 2017.

The WHO did not mention with one word that the increasing use of stimulants on prescription is also a huge problem. This is taboo.

There were 10,333 drug overdose deaths in USA in 2017 involving stimulants,541 compared to only 1,378 in 2007. Meth is regarded as particularly dangerous. We don’t know how many people are killed by stimulants on prescription.

But we do know that stimulants increase the risk of violence,34,401 including suicidal and homicidal ideation,34 which is not surprising, given their pharmacological effects.

We should not change children’s brains but their environment

Doing the right thing in psychiatry is often not allowed by the psychiatric guild. An Irish child psychiatrist told me he was suspended because he didn’t put his children on psychiatric drugs, including ADHD drugs.

Instead of changing our children’s brains, likely permanently, we should change their environment. ADHD medications are prescribed much more to children if the parents have low-skilled jobs.542 The drugs are used as a form of social control, just as psychosis pills are, and the soma pill was in Aldous Huxley’s novel, Brave New World.

Sexual abuse of children is frighteningly common. You can easily find references on the internet to the fact that about one in ten children have been sexually abused before their 18th birthday. If a child behaves badly, is provocative and defiant, this can easily lead to a diagnosis of ADHD or borderline personality disorder, although it might be a reaction to a horrible situation of ongoing sexual abuse that the child doesn’t dare talk about to anyone.

Not even when the patients talk about it, is it always taken seriously. A young women told me that when she mentioned to her psychiatrist that she had been sexually abused as a child, he responded: “This is beside the point.” Of course. He used the foolish questionnaires for making diagnoses, which was all that mattered to him. Many patients have told me it took many years before they met a psychiatrist who took an interest in the serious trauma they had experienced.

One of my critical colleagues, child psychiatrist Sami Timimi, often asks parents who want him to drug their child for ADHD:46 “Imagine this drug working perfectly; what changes are you hoping will result from this?” That question may surprise parents, but if you say no more, one of them will break the silence and start talking about what changes they are hoping for. That helps Timimi understand the parents’ specific areas of concern. Is it, for example, behaviour at home, peer relationships, academic performance at school, a lack of a sense of danger? Timimi might then respond that no drug in the world can alter these things in their child. Drugs don’t make decisions, have dreams and ambitions, or perform actions.

By discovering the specifics of what the parents want to see change, Timimi can divert their interest from drugs to more targeted measures such as developing parental management skills for children who are more “intense” than most. He helps them understand the anxieties and stress their children may be feeling, or he supports them getting more structured interventions in schools. He also reminds parents that one thing is certain: Children change as they grow older and often the problems labelled as ADHD (particularly the hyperactivity and impulsivity) tend to go away as the child matures during adolescence.

As noted earlier, this agrees with observations in school classes: 50% more of those born in December were in drug treatment than those born in January.51

One textbook claimed that most neurobiological studies of patients with ADHD suggest that the abnormal findings in the brain are gradually normalised by late maturation of the brain as well as by treatment.18:224 This is not correct. The brains are not abnormal (see (see Chapter 2, Part Two and Chapter 3), and drugs cannot normalise what is already normal.

The ADHD diagnosis should not be a prerequisite for getting extra help or money for schools, which it is now. This requirement drives the prevalence of the diagnosis upwards all the time, and the use of ADHD drugs, too, which increased by 240% in Denmark from 2007 to 2017.263

Some countries have experienced an increase in the use of psychiatric drugs in children that is directly attributable to school partnerships with hospitals. A colleague informed me that, in one Canadian province, the hospitals aggressively lobbied special services personnel and high school guidance counsellors, who in turn referred any child under stress to the psychiatric department. The school board hired a school psychiatrist who consulted with staff on school refusal situations and behavioural issues and recommended depression pills or ADHD drugs.

Schools and hospitals have become dangerous places for children and adolescents. How sad this is. Schools should stimulate children, not pacify them with speed on prescription. In USA, you can be met with this warning:

Sign reading "DRUG FREE GUN FREE SCHOOL ZONE"

But inside the gate, about 10% of the children have an ADHD diagnosis543 and are on speed.

It is a paradox that teachers act as more effective drug pushers than those in the streets. People dependent on amphetamine can experience severe withdrawal symptoms that can last for weeks and which include dysphoria, irritability, melancholia, anxiety, hypersomnia, marked fatigue, intense craving for the drug, and paranoia.544

I have this advice to people:8:67

1) Don’t ever accept that your child be treated with speed on prescription.

2) Don’t ever accept this yourself but resist becoming a faceless number in the new legal market for speed for adults.

3) Approach children with patience and empathy that allow them to grow up and mature, without drugs.

4) Work on changing the mechanisms that label more and more children with a psychiatric disorder; they must be able to get the help they need without getting a diagnosis first.

ADHD is a disaster area, both in terms of the diagnosis, clinical research, and the harms inflicted on hundreds of millions of healthy people, including 10% of our children. All ADHD drugs should be removed from the market and the diagnosis should be banned.

Danish child and adolescent psychiatrist Lisbeth Kortegaard and US psychiatrist Peter Breggin111:197 have gradually withdrawn ADHD drugs from every child that came their way and have both experienced that it improves the child’s condition given the parents agree and work on improving their parental skills.

A British documentary was very revealing about what is needed.8:65 It showed highly disturbing children, which were so difficult to deal with that even critical psychiatrists might conclude that ADHD drugs are necessary. “We cannot have children hanging around in the curtains,” as a child psychiatrist told me at a hearing in Parliament about the drugging of children. The families in the documentary got help from psychologists and it turned out that the children were disturbed, which was why they were disturbing. One mother who always reprimanded her “impossible” daughter was taught to praise her instead, and somewhat later, she had developed into a very nice child that was no longer difficult or hostile towards her mother.

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To see the list of all references cited, click here.

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4 COMMENTS

  1. I’m all on board for not medicating children, but adhd stays into adulthood for a good percentage of diagnosed children. Once the brain is developed, why would you deny someone the ability to treat their symptoms that severely impact their daily life? Yes, stimulants come with their own set of dangers, but at doses effective to manage adhd, most (if any) of the adverse effects shouldn’t be present. If you’re mad enough to write this tirade, I’d be curious to hear what you think of benzos, which I’d argue are much worse and more sinister.

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  2. Thank you, Dr. Peter, for always speaking the hard truth.

    I will say this weekend I learned that it may be possible to rid the world of the “invalid” DSM disorders. Or, hopefully so.

    I had to take a loved one into the hospital, due to an abrupt non-psychiatric drug withdrawal issue – which did turn into, as was blatantly obvious to me, to be a drug withdrawal induced manic psychosis.

    Thankfully, I’d already done my homework, and knew enough to tell my loved one’s nurses and admitting doctors, that we had a family history of extremely bad reactions to the anticholinergic drugs.

    So the hospital doctors put my loved one on a benzo, which I agreed to for three days.

    Three days later, my loved one seems no longer to be psychotic. Maybe we should be trying to get rid of psychiatry, since it seems to be nothing more than a lying, cheating, scientific fraud based, iatrogenic illness creating, and iatrogenic illness covering system, for profit?

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  3. While I agree that stimulants are overprescribed, there are some misleading implications in this article.
    1. Obetrol is the same as Adderall
    The Obetrol formulation which was removed from the market by the FDA was a combination of amphetamine and methamphetamine salts; the increased addictive potential of methamphetamine relative to amphetamine is well-supported and Obetrol was not the only methamphetamine drug of the time with this issue. It was later reformulated to contain only salts of amphetamine, and it is that formulation that became Adderall.
    2. It is implied that Canada pulled Adderall permanently in 2005, when this in fact lasted yes than a year and resulted in a warning that Adderall should not be used in patients with certain cardiac abnormalities.
    I myself have a diagnosis of ADHD in adulthood, though the symptoms were very clearly present since early childhood – noted by my parents, teachers, and others – and simply persisted; I did not “grow out” of it as you suggest is typical. In childhood I was able to overcome the learning difficulties of ADHD by completing my work quickly, before my attention could wander, and with a great deal of understanding support from my parents and teachers. Later, in college and the workplace, I have had to sustain my attention for longer spans, and this was simply not possible until I started stimulant treatment. Before then, even driving a car was a fraught activity as I found it difficult to keep my attention in one place. One could certainly argue that humans were never meant to drive a car, so my natural attentional state is “normal” and probably adaptive in a hunter-gatherer society, but the modern world is quite different from that, and driving is one of many activities requiring extended focus.
    So while stimulants are overprescribed and ADHD overdiagnosed, I challenge the implicit assertion that most or all ADHD patients are within the range of function required to function in the modern world.

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